Burda on Healthcare: Always, Often, Sometimes, Rarely or Never Trust What the AMA Tells You About Prior Authorization

The American Medical Association (AMA) released the results of its latest annual survey of physicians on prior authorization (PA). This year’s report, released last week, is based on a December 2023 survey of 1,000 physicians.

The report paints a pretty grim picture of the negative effects PA is having on patients, physicians and the healthcare system generally. What the report doesn’t do is tell you whether that picture is more grim or less grim than the one painted by previous year’s reports. That’s your first red flag: no comparative survey data.

The second red flag is any link to last year’s report takes you to this year’s report. Even the AMA’s March 13, 2023, press release on last year’s report takes you to this year’s report. It’s the same with any link in any story about last year’s report. Here’s a March 14, 2023, story in MedPage Today on last year’s report that links to this year’s report.

It even happened in one of my columns from last year. In “Dead Patient Walking,” I cited last year’s report in a piece on all the different things that can kill you as a patient before you get medical care. When you click the link to the 2023 report, you get the 2024 report. I don’t like that.

The how probably is pretty easy. Just switch the asset on the receiving end of the same link wherever it is and poof! The why isn’t so clear.

On the innocent end of the spectrum, the AMA may just be trying to be helpful and give us access to the latest information possible on the consequences of PA from the point of view of organized medicine. Or maybe it was the result of some kind of website update or refresh. On the not-so-innocent end of the spectrum, the AMA just may not want you to see the 2023 report or any results from past-year surveys.

I’m leaning toward the latter end of the spectrum for three reasons. First, as much as I try, I just can’t find the 2023 report or any of the results from past AMA surveys on the PA research and reports section of the AMA’s website.

Second, when I look at the 2023 report and compare it with the 2024 report released last week, what doctors think of PA got slightly less worse. I’m guessing that’s not something the AMA wants anyone to notice, especially as they continue lobbying federal and state governments for legislative and regulatory relief from PA requirements.

Comparing this year’s report (2023 survey results) with last year’s report (2022 survey results):

• The percentage of physicians who said PA “always” or “often” delayed a patient’s access to necessary care dipped to 55% from 56%.
• The percentage of physicians who said PA “always” or “often” resulted in a patient abandoning a recommended course of treatment slipped to 22% from 28%. In fact, no doctor in the 2023 survey said PA “aways” forced a patient to abandon care.
• The percentage of physicians who said PA led to a serious adverse event for one of their patients dropped to 24% from 33%.
• The percentage of physicians who said PA led to the hospitalization of a patient declined to 19% from 25%.
• The percentage of physicians who said PA led to a patient disability, permanent bodily damage, congenital anomaly/birth defect or death came down to 7% from 9%.

Are these changes in how physicians feel about PA significant? Maybe? Maybe not? What is significant is you wouldn’t know about the changes unless you kept last year’s report.

The third reason is I used to cover the AMA as a reporter and editor. Certain behaviors are ingrained in the AMA’s culture.

What’s the lesson here? The first lesson is that most physicians still think PA stinks, but a few of them think PA stinks slightly less than it did before. The second lesson is never throw anything away from the AMA.

Thanks for reading.

More on Prior Authorization

COMMENTARY

Dead Patient Walking 
Prior authorization is responsible for a ton of risk, including delayed access to care and patients who abandon the recommended course of treatment. PA isn’t just annoying, it’s killing people. More.

BLOG
The Costly Lever of Prior Authorization 
Prior authorization doesn’t just affect patients — it weighs down physicians and support staff who are leveled with the administrative burden. Let’s cut down attention on PA and put the focus where it belongs: on patients. More.

BLOG
No Pandemic Impact to See Here. Doctors Still Hate Prior Authorization. 
There’s not much in healthcare that stays the same but there’s one thing that can’t be shaken. Consistently, physicians continue to hate on prior authorization policies from public and private health insurers. More.

PODCAST
Rethinking Medicare Advantage 
New prior authorization rules sent Medicare Advantage into a tailspin. Where does prior authorization fit in among the turmoil? Hear more about the way forward for payers, providers and patients on this episode of the 4sight Health Roundup podcast. Listen.

BLOG
Prior Authorization Is a Big Waste of Time  
Looking for the real truth about prior authorization? It’s buried in a short section of MedPAC’s June 2024 report to Congress. You can dig in there or you can read this short blog from 4sight Health’s David Burda. More.