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November 21, 2023
David Burda
Economics Outcomes Policy

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.

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About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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