Prior Authorizations: Impact on Patient Outcomes and Provider Burnout

A scoping review published in JAMA Neurology indicates that the use of prior authorizations (PAs) is linked to poor patient outcomes and increased burnout among healthcare providers.

Prior authorization is a cost-control process utilized by health plans. It requires healthcare professionals to obtain advance approval from the health plan before a medical service or prescription medication can be delivered to a patient and qualify for payment.

Impact on Patient Care and Clinical Outcomes

The review identified significant negative consequences for patients resulting from these administrative requirements. The most frequently cited consequence was delays in care, which affected 60% of the cases identified in the review.

Beyond initial delays, the review found that 25% of the identified consequences involved increased disease activity. These findings suggest that the administrative barriers created by prior authorizations can directly interfere with the timely delivery of therapy and the stability of a patient’s health status.

Additional data regarding perceptions of these burdens highlights a discrepancy in how delays are reported. While 26% of patient respondents reported frequent delays in care, 92% of provider respondents reported the same issue.

Provider Burden and Systemic Strain

The administrative demands of the prior authorization process contribute significantly to provider burnout. Physicians and other healthcare providers find these requirements burdensome, contrasting with the position of benefit managers and health plans who maintain that PA programs are necessary for controlling costs.

The burden is compounded by other systemic pressures within the healthcare environment. For instance, data from the American Medical Association indicates that drug shortages affect 88% of primary care physicians, further complicating the delivery of care already hindered by administrative hurdles.

The Conflict Between Cost Control and Care Delivery

The tension surrounding prior authorizations centers on the balance between financial oversight and clinical efficacy. Health plans utilize these tools to ensure medications and services are necessary and cost-effective.

However, the evidence from the JAMA Neurology scoping review suggests that these cost-control measures may lead to adverse clinical results. When therapy is delayed due to the approval process, the window for optimal intervention may close, leading to the observed increase in disease activity.

The disparity in reporting delays between patients and providers may reflect different perspectives on what constitutes a delay, but the high percentage of providers reporting these issues underscores the operational strain placed on medical practices.