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AMA Survey Finds Prior Authorization Linked to Serious Patient Harm, Sparks Urgent Call for Reform

The American Medical Association (AMA) has released findings from its recent survey, shedding light on widespread physician dissatisfaction with prior authorization protocols. The "2023 AMA Prior Authorization Physician Survey" underscores significant challenges faced by healthcare providers in navigating these processes, which many describe as detrimental to patient care.

Conducted among 1,000 practicing physicians, including specialists and primary care doctors, the survey reveals a profound impact on patient outcomes. A striking 24 percent of respondents reported that prior authorization requirements have directly contributed to serious adverse events for patients under their care. Additionally, a staggering 93 percent of physicians noted negative implications for clinical outcomes due to these administrative hurdles.

Key concerns highlighted in the survey include delays in necessary care, with 55 percent of physicians indicating that prior authorization processes frequently or always impede timely access to treatments. Moreover, a notable 35 percent of respondents expressed doubts about the evidence-based nature of prior authorization criteria.

Appealing denials emerged as another significant challenge, with nearly half of physicians citing insufficient resources or time to effectively challenge adverse decisions. A substantial portion of respondents (35 percent) reported allocating dedicated staff solely for managing prior authorizations, highlighting the administrative burden these processes impose on healthcare practices.

Regarding denial rates, 27 percent of physicians stated that prior authorizations are frequently or consistently denied. Alarmingly, 73 percent observed an increase in denials over the past five years, suggesting a growing barrier to delivering prompt and effective care.

In response to these findings, AMA President Bruce A. Scott, M.D., emphasized the urgent need for legislative reform to address these issues. Dr. Scott underscored the detrimental impact on patient well-being when administrative hurdles delay or deny essential treatments, potentially escalating healthcare costs as conditions worsen.

Dr. Scott stated, "Physicians witness firsthand the harmful consequences of prior authorization, which can lead to patients foregoing necessary care or facing worsened health outcomes. It's imperative that lawmakers prioritize patients' access to evidence-based treatments by curbing excessive administrative requirements."

The AMA's call for reform aims to mitigate the adverse effects of prior authorization, advocating for policies that streamline processes, reduce administrative burdens on healthcare providers, and ultimately enhance the quality of care delivered to patients.

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