It’s no secret that the prior permission procedure irritates both physicians and patients, but new research demonstrates exactly how much this ineffective procedure can restrict patients’ access to care and lead to medical problems that could be easily avoided.
According to the 2018 AMA Prior Authorization (PA) Physician Survey, a startling 91% of patients reported that the PA procedure caused a delay in receiving necessary care.
What’s more alarming is that according to 28% of doctors, the PA process has caused major medical events like hospitalization, incapacity, permanent physical harm, a life-threatening situation, or death.
Care delays brought on by prior authorizations are a rising issue since PAs are on the rise, which makes the situation even more critical.
According to a Porter Research study of executives in healthcare revenue cycle management and care management, over the previous two years, the number of medical procedures requiring prior authorization has significantly increased in 99% of firms.
PA Delays: Problems with Adherence and Abandonment
Delays in PA are frequently linked to problems with treatment adherence, a problem with epidemic scope that is completely avoidable.
According to the Annals of Internal Medicine, non-adherence to medication alone causes between 125,000 and 289,00 deaths annually and costs the healthcare system between $100 billion and $289 billion.
According to studies, 20 to 30 percent of prescriptions for medications are never filled. Statistics indicate that prior authorization delays frequently result in treatment being stopped, while it is unclear how many of these incidents are specifically related to PA delays.
75% of doctors who responded to the AMA study claimed that PA problems have led patients to forego the suggested course of treatment.
Ninety one percent of doctors said previous authorisation delays had a considerable or somewhat unfavorable impact on clinical results.
It goes without saying that when it comes to patient care, the current prior permission procedure is just inadequate. Care delays brought on by PAs can and need to be avoided.
Why Prior Electronic Authorization is Insufficient
Even though the industry has been dealing with a laborious, paper-intensive procedure for years, electronic prior authorizations (ePAs) are still not quite effective enough to avoid major delays.
Even though the modern method uses fewer faxes and phone calls, ePAs still take a lot of man-hours to complete.
Consider the fact that prior authorizations take doctors and their staff an average of two business days per week to handle, with each doctor handling about 31 PAs each week.
According to the AMA poll, more than one in three doctors employ staff members who are solely responsible for previous authorizations.
The majority of firms require an average of one week to secure a prior authorization, according to the Porter research.
The survey discovered that 65% of hospitals with more than 500 beds had more than 15 FTEs devoted to processing prior authorizations, allowing them to handle PAs more quickly but at the expense of additional resources.
Staff members must frequently visit several portals, manually locate missing data, and adhere to varied workflows for particular procedures or medications when processing ePAs, which can take time.
The Answer: Accelerating Prior Authorization
Better patient care is only possible with truly automated PAs (aPAs). Everyone wins, but the patient is most essential, when healthcare professionals, payers, pharmacists, and manufacturers can access and exchange data more effectively.
Prior makes it easier for all stakeholders to communicate on one independent open platform as opposed to working in silos and stitching information together via phone calls, faxes, numerous portals, and endless piles of paper.
Even better, this one central platform may be used to obtain prior authorizations for a wide range of medical operations as well as for lab and pharmaceutical authorizations. The first business to offer this breadth of coverage on a single, integrated platform with any automated prior authorization software.
It manages the submission process, so providers no longer need to access numerous separate payer websites to provide prior authorizations. Beyond what ePAs can accomplish, this fully automated system saves providers a substantial amount of time and money.
The Advantages: Better Treatment and Patient Results
Prior authorizations can be processed with less expense, time, and labor by automating the procedure. APAs can increase patient satisfaction while using fewer resources, which has a direct impact on adherence, HCAHPS ratings, and other factors.
Prior authorization services may be made much easier while saving money thanks to clever automated workflows and easy data sharing.
Less time spent on the procedure allows for enough resources to be allocated to other high priority areas.
Prior authorization turnaround times are shortened by streamlining communications between doctors, payers, and pharmacies, increasing everyone’s productivity and efficiency.
APAs enable all stakeholders to monitor the progress of pending authorization requests as they are reviewed and approved. More transparent discussions are also made possible by having access to PA performance data.
Automating prior authorizations provides numerous advantages for all parties concerned, but patients are the most crucial. The beginning of faster, more efficient interactions with physicians, payers, and pharmacists.
Lessening delays can greatly enhance patient care and stop unnecessary health problems.