Doctors voice frustration with insurer preauthorization requirements

Preauthorization requirements not only are a source of frustration for physicians, but they also create delays that interfere with patient care, according to thousands of physicians surveyed by the American Medical Association.

The AMA conducted an online survey of 2,400 physicians in May to gauge the effect of preauthorization requirements. It released the findings Nov. 22.

Ninety-five percent of physicians surveyed said it was "very important" or "important" to eliminate hassles caused by preauthorization requirements.

Three-quarters of physicians responding said they supported an automated preauthorization process.

"Intrusive managed care oversight programs that substitute corporate policy for physicians' clinical judgment can delay patient access to medically necessary care," AMA Immediate Past President J. James Rohack, MD, a cardiologist from Bryan, Texas, said in a statement.

Susan Pisano, spokeswoman for the insurance trade group America's Health Insurance Plans, declined to address the survey findings specifically, but said AHIP members continue to work to streamline the preauthorization process.

"Physicians are right to be looking for efficiencies," she said. "We have been working with the physician community to figure out how to move forward and make the daily transactions that go on as efficient as possible."

Part of the problem surveyed physicians identified was figuring out which drugs, tests and procedures require preauthorization, because the rules vary by benefit plan. In the survey, 64% of physicians said it was difficult to figure out which tests and procedures need preauthorization, and 67% said the same about drug preauthorizations. Once it's clear that they need preauthorization, doctors say they are accustomed to waiting as long as a week for an answer.

Of the physicians who answered the survey, 63% said they typically wait "several days" for an answer about a test or procedure, and 13% said they wait more than a week. For drugs, 69% said they wait several days, and 10% said they are used to waiting more than a week.

Roland Goertz, MD, a family physician from Waco, Texas, and president of the American Academy of Family Physicians, said that in the 1990s, insurers used preauthorizations as a simple barrier to care -- just to see how many physicians would appeal if they were initially denied.

While there are a few cases when preauthorization requirements are useful for dissuading patients who ask for things they don't need, most of the time the administrative burden seems to serve insurers' bottom line, not improved care, Dr. Goertz said.

It may seem like insurers place preauthorization requirements based on cost, Pisano said, because "in many instances, expensive procedures are also invasive procedures."

The AMA survey quantified how much time physicians and insurers spend on preauthorization rejections and subsequent appeals. Asked what percentage of their first preauthorization requests are denied, 37% said at least 20% of their initial requests for tests and procedures were denied, and 57% said they had at least 20% of drug preauthorization requests denied.

More than half of physicians reported that they appealed 80% or more of those denials for tests and procedures, and 39% said they appeal 80% or more of the drug preauthorization denials.

The findings follow research conducted by the Medical Group Management Assn. published in May 2009 in Health Affairs, which showed that physicians spend an average of more than three hours a week dealing with preauthorizations, costing their offices collectively between $23.2 billion and $31 billion a year. Primary care physicians spend more time on these tasks than their specialist counterparts, according to that research.

The MGMA recommended that the insurance industry work to automate much of the process to streamline and cut the cost of preauthorizations, but the results of the AMA survey suggest little has changed in the last year.