According to a December 2017 study from the American Medical Association, 86% of physicians report that prior authorizations have increased during the last five years and 51% report that they have increased significantly.
While payers and providers debate the true intent of increasing prior authorization requirements, many physicians believe that the true motivator of prior authorizations is the bottom line for payers, not necessarily patient care. In the eyes of physicians, prior authorizations are a way for insurance companies to control health care usage, and some view prior authorizations as an attack on their autonomy, years of training, and ability to care for their patients. Plus, there’s the time wasted and revenue lost due to negotiating with payers over approval for procedures.
While those of us in revenue cycle certainly acknowledge that prior authorizations are a burden for administrators, just how much of a burden they are for clinicians may come as a surprise.
Let’s just say they’re time-consuming.
The average time spent per physician is 14.6 hours to complete 21.9 prior authorizations per week. That’s the equivalent of two working days, often with the clinician working on prior authorizations during their off-hours or personal time.
Additionally, more than 60% of physicians said they waited at least one business day to complete prior authorizations, while 30% said they often wait three business days or longer.
And according to the AMA survey, more than 90% said that prior authorizations have a negative affect on patient care, either through delay of care or forced treatment abandonment.
And it’s complicated…
A McKesson study of 23 different health plans found 1,300 procedure-specific authorization policies with only 8% commonality. So it only makes sense that 84% of physicians say prior authorization burdens are “extremely high”.
In fact, 34% of organizations report hiring staff members exclusively dedicated to prior authorizations. Assuming 15 hours per physician per week, that’s 1 full-time employee for every 2.7 physicians. And those extra salaries add up… fast. Anywhere from $83-85K is spent each year per full-time physician on the prior authorization process. That equates to $23-31B annually across the U.S. healthcare system.
If you have a provider facility with 22 doctors, you’ll need 8 extra employees just to stay afloat in the sea of prior authorizations.
But staying afloat won’t cut it, and your employees can tell. In fact, 54% of physicians report at least one symptom of burnout, and physician burnout costs the healthcare industry $4.6B annually.
How can you help?
1. Keep lists and references up-to-date and easy-to-access. Payer criteria, state law, and common “trigger” medication information should be kept on hand and updated often, so physicians and staff know what to include in requests. Focus especially on payers that insure the majority of your patient base.
2. Assign each staff member their own set of payers. Familiarize each employee with their assigned payers’ processes, including preferred methods of communication. Then, streamline work queues to reflect your staff’s new specializations.
3. Encourage staff to keep physicians informed. So when prior authorization issues arise (and trust us, they will), physicians won’t be blindsided with extra administrative work and can prepare secondary plans for care if needed. As communication increases, staff stress and potential burnout will decrease. Drastically.
4. Follow prior authorization requests through their entire life-cycle. Don’t lose sight of prior authorizations and their status in the hustle and bustle of practice activity. Track what types of care are frequently denied (and approved) and why. Then, actually apply that newfound knowledge.
5. Switch to electronically submitted transactions. The 2017 CAQH Index states that a single manual prior authorization costs $5.75 and takes around 20 minutes of staff time. Utilizing electronic transactions, however, could save you a total of $245 million and 9 minutes per transaction.
Manual transactions require additional staff, making it quite costly. And since staff must then spend valuable time either on the phone with payers or searching websites for information, it is also time-consuming.
Electronic transactions, especially when automated, are the fastest method. Allowing staff to reallocate those hours spent on the phone to more meaningful work, like spending time with patients, or more targeted work, like only working necessary accounts, gives you a higher yield per employee and gives your staff stress alleviation (which means less burnout).
The Wrap Up
Payers are requiring more prior authorizations and navigating benefit requirements is growing more complicated as plan types increase. As a result, obtaining prior authorizations continues to compound the administrative burden on providers — and it’ll only get worse from here. You need to invest the time needed to improve your prior authorization workflow or risk an increase in employee burnout, wasted time, and money lost.