Inefficient Payer Approval Processes Fail Patients, Frustrate Docs

2017-03-01 | , AACU and Urology Times

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or for more information.

March 2017 - Prior authorization. Preauthorization. Prior approval. Pre-approval. No matter what you call it, these "utilization management" schemes that consume more and more of urologists' days can be redesigned to make them more relevant and more efficient. This is demonstrated by recent attempts to simplify the administrative burden via state law, as well as a set of principles laid out by the American Medical Association and a coalition of physicians, medical groups, hospitals, pharmacists, and patients.

"Preauthorization has escalated beyond reason," according to AACU President Charles McWilliams, MD. "The list of services that require approval seemingly gets longer every few months. My staff spends at least 30 to 60 minutes for every surgery and medication preauthorization."

According to a December 2016 survey of 1,000 physicians conducted by the AMA, 90% of respondents reported that the prior authorization process delays access to necessary care. AACU Health Policy Chair Jeffrey Frankel, MD, said, "Prior authorizations are very disruptive to patient care and have, in a big way, allowed insurance companies to practice medicine without a license."

The AMA survey found that 80% of physicians are "sometimes, often, or always required to repeat [prior authorization] requests for prescriptions when the patient has already been stabilized on a treatment for a chronic condition."