Specifically, 94% of physicians said PA led to care delays at least some of the time, with 42% saying that these delays in care happened "often" and 14% saying that delays "always" happened with PA. In addition, 80% of physicians said that PA can at least sometimes lead to patients abandoning a recommended course of treatment.

A third of physicians also reported that PA has led a patient in their care to experience a serious adverse event. Other potential harms faced by patients include hospitalization, life-threatening events, or permanent bodily damage/death.

Current efforts to reform prior authorization

According to AMA, the survey's findings underscore an urgent need to better regulate and reform the PA process to benefit both physicians and patients.

In December, CMS issued a proposed rule to overhaul the PA process, streamlining requests and sharing healthcare data more readily. The deadline to submit comments on the proposed rule was March 13.

Under the proposed rule, state Medicaid agencies and Medicare Advantage (MA), Medicaid managed care, and Affordable Care Act plans all would be required to improve their PA processes and respond to requests more quickly.

The proposed rule would require insurers to respond to "urgent" requests within 72 hours and standard requests within seven days — half the time MA plans currently receive to respond to PA requests. Insurers also would be required to justify any denials and publish data on their PA decisions.

"The prior authorization and interoperability proposals we are announcing today would streamline the prior authorization process and promote healthcare data sharing to improve the care experience across providers, patients and caregivers," CMS Administrator Chiquita Brooks-LaSure said when the rule was first proposed.

According to CMS estimates, the proposed rule will generate more than $15 billion in savings for providers over the next 10 years. So far, both provider and payer groups have had largely positive responses to the proposed rule.

"The [American Hospital Association] commends CMS for taking important steps to remove inappropriate barriers to patient care by streamlining the prior authorization process for some health insurance plans," said Ashley Thompson, AHA's SVP for public policy analysis and development. "Prior authorization is often used in a manner that results in dangerous delays in care for patients, burdens healthcare providers and adds unnecessary costs to the healthcare system." (Morse, Healthcare Finance, 3/28; AMA 2022 Prior Authorization Physician Survey, accessed 3/29)