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Are health insurers willing to reform PA process? AMA has its doubts

Are health insurers willing to reform PA process? AMA has its doubts

CHICAGO – The health insurance industry has made little progress in reforming prior authorization processes, according to the results of a new survey of physicians from the American Medical Association. 

In January 2018, the AMA and other national organizations signed a consensus statement outlining a shared commitment to five key reforms to the prior authorization process that promote safe, timely and affordable access to evidence-based care for patients, enhance efficiency and reduce administrative burdens. 

However, findings from the survey question whether the health insurance industry can be relied upon to voluntarily expedite comprehensive reform to the prior authorization process. 

“Waiting on a health plan to authorize necessary medical treatment is too often a hazard to patient health,” said Gerald E. Harmon, M.D., president of the AMA. “Authorization controls that do not prioritize patient access to timely, optimal care can lead to serious adverse consequences for waiting patients, such as a hospitalization, disability or death. Comprehensive reform is needed now to stem the heavy toll that continues to mount without effective action.”   

The survey, conducted in December 2021, examines the experiences of more than 1,000 practicing physicians with each of the five reforms in the consensus statement and illustrates that the goal of comprehensive reform is far from complete.


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