No Pandemic Impact to See Here. Doctors Still Hate Prior Authorization.

With the COVID-19 pandemic largely in our rearview mirror, many health services researchers are doing before-and-after studies. Infection rates before and after the pandemic. Healthcare employment levels before and after the pandemic. Patient telemedicine use before and after the pandemic. Provider profit margins before and after the pandemic.

Based on what I’m reading, researchers are finding that the pandemic, a once-in-a-century public health crisis, did have an impact on whatever it is they’re studying, as you would expect.

One thing that didn’t change pre- and post-pandemic is physicians’ hatred of prior authorization policies from public and private health insurers. That’s according to my look back at five years’ worth of Medical Group Management Association regulatory burden surveys.

The MGMA released its 2023 report, based on a survey of executives from more than 350 medical group practices, last week.

Prior authorization ranked No. 1 on MGMA’s list of regulatory burdens, cited by 89% of the respondents as being “very” or “extremely burdensome.” It ranked:

• No. 1 in 2022, cited by 82% of the respondents.
• No. 1 in 2021, cited by 88% of the respondents.
• No. 1 in 2019, cited by 83% of the respondents.
• No. 2 in 2018, cited by 82% of the respondents. (The Medicare Quality Payment Program was No. 1, cited by 88% of the respondents.)

(I guess the pandemic did have an impact as the MGMA didn’t conduct a survey in 2020.)

Why do doctors hate insurers’ prior authorization rules so much? First, if you were to rank people based on how much they don’t like other people telling them what to do, I’d put doctors first. Reporters would be next. Second, it interrupts their clinical workflows similar to clunky EHR systems. Third, it disrupts their ability to care for their patients.

Medical practices’ top three beefs with prior authorization, according to the MGMA survey, are delays in prior authorization decisions, prior authorizations for routinely approved services and treatments, and inconsistent payer payment policies. Further, 97% said prior authorization requirements delay or deny necessary care to their patients. Ninety-two percent said an increase in prior authorization requests is forcing them to hire or redistribute staff to deal with it.

In an industry rocked by a pandemic, it’s nice to know some things never change.

To learn more about this topic, please read:

• “More Than Three-Quarters of Medical Practices Say Provider Consolidation is Bad for the Industry”
• “Same Old, Same Old When It Comes to What Doctors Don’t Like”
• “Ranking the Regulations that Bother Doctors”