The Smart Medical Practice

Prior Authorization Identified As Top Cause of Physician Dissatisfaction


Study Shows That After EHR, Preauthorizations are The Next Factor in Physician ChurnAMA Study Shows That Behind EHR, Preauthorization is a Key Component in Physician Frustration

 

There’s been a great deal of talk in recent years about physician burnout and dissatisfaction. Asked what they’d most like to change, virtually all talk about not being able to spend enough time with patients. But what, exactly, keeps them from that all-important face time?

In 2016, the American Medical Association (AMA) sought answers to this question by asking 38 physicians in family medicine, internal medicine, cardiology, and orthopedic surgery about their level of satisfaction/dissatisfaction and their suggestions for change. In addition, interviewers asked about the amount of time dedicated to five task categories: prior authorization, medication refills, between-visit care, test results, and claims processing.

Not surprisingly, the study found physicians derive satisfaction from providing good medical care and taking care of patients. The largest source of dissatisfaction was EHR/desk work—and right behind that was prior authorization.

The main theme around prior authorization was wasted time. Physicians talked about spending hours each day on this task and expressed frustration with the opaqueness and repetitiveness of the system.

Because payers don’t offer an alternative when denying authorization of a particular medication, physicians are forced to guess. If they guess wrong (i.e., the second medication isn’t covered, either), they’re back at square one. In the meantime, the patient is not being well served, and multiple staffers must perform multiple tasks to rectify the situation.

When asked what changes they’d like to see, physicians talked about eliminating preauthorization altogether or streamlining and adding transparency to the system.

The study found very serious consequences from these dissatisfiers. The amount of time spent on paperwork and minutia takes away from taking care of patients, one physician said. There’s also an element of disrespect of physician expertise by payers. “I don’t like people who don’t know anything [about clinical medicine] second-guessing my patient care,” said one physician.

Indeed, physicians expressed frustration with being forced to change a prescription or course of treatment based on what the payer would or would not authorize, as well as with changes in formularies that affect their ability to continue to prescribe a medication a patient has been on for many years.

In their conclusion, the study-authors point to the wide variation of communication channels, processes, workarounds, and utilization of technology as a ubiquitous issue.

“Staff members from each practice described multiple channels of communication with pharmacies, payers, and patients…[and] the vast majority expressed some level of dissatisfaction with the burden of coordinating these current communication methods,” they write.

There’s a distinct lack of innovative and sustainable solutions to those gaps, say the authors, pointing out that workarounds like fax machines and sticky notes offer virtually no security and have little presence in most other modern industries.

Closing that gap would go a long way toward alleviating physician pain around prior authorization, the authors conclude. They write: “These challenges provide more evidence supporting the need for standard, system-wide processes and consistent, modern methods of communication between physicians and their staff, health plans, patients, and pharmacy professionals.”

 


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