Providers

When Prior Authorization are Delayed, Patients Suffer

The SamaCare Team

The SamaCare Team

We have written in the past about the impact of getting prior authorizations approved before the intended date of service. This is indeed one of the most important metrics SamaCare looks at to help practices reduce negative consequences of a burdensome prior authorization process on patient care. However, it is important to understand exactly what those negative consequences are — how do patients suffer when prior authorizations are delayed or denied?

SamaCare conducted a recent survey of practitioners across specialties, who frequently prescribe physician-administered medications that require prior authorization. In the survey, we asked providers three key questions around the impact of prior authorizations on patient care: 

1. How does the prior authorization process impact patient care?

… of providers indicated prior authorizations have a “highly negative” or “somewhat negative” impact on patient care.

2. How do prior authorization delays or denials impact patients' likelihood to adhere to a treatment plan?

… of providers indicated prior authorization delays,  denials have a “highly negative” or “somewhat negative” impact on patients’ likelihood to adhere.

3. How does the prior authorization process impact patient outcomes?

… of providers indicated the prior authorization process has a “highly negative” or “somewhat negative” impact on patient outcomes.

Interpreting the Results 

The reported impact of prior authorization on patient care varies somewhat from specialty to specialty. For example, 100% of retina providers indicated prior authorization delays and denials negatively or somewhat negatively impact patients’ likelihood to adhere to a treatment plan, compared to 86% of providers across all specialties surveyed. Impact on patient care may differ by prognosis as well. Of rheumatologists surveyed, 100% indicated the prior authorization process negatively or somewhat negatively impacts patient outcomes. To put a human lens on this statistic, delays in treatment may impact a patient’s likelihood of long-term disability. For example, for rheumatoid arthritis, delays in treatment mean continued bone destruction and secondary soft tissue swelling. For autoimmune diseases like Lupus, the course of the disease progresses and causes additional long term damage as time passes. Depending on the disease, bones, tissue, organs all can be irreversibly damaged by delays in treatment. In one stark example supporting this point, a study of 3.6 million patients by researchers at the Cleveland Clinic showed delays in treatment for newly diagnosed cancer patients are associated with a significantly increased risk of death. 

What is clear from the survey SamaCare conducted is that specialists with experience prescribing physician-administered medications that require prior authorization overwhelmingly agree — inefficiencies in the prior authorization process hurt patients.


Providers

When Prior Authorization are Delayed, Patients Suffer

The SamaCare Team

The SamaCare Team

We have written in the past about the impact of getting prior authorizations approved before the intended date of service. This is indeed one of the most important metrics SamaCare looks at to help practices reduce negative consequences of a burdensome prior authorization process on patient care. However, it is important to understand exactly what those negative consequences are — how do patients suffer when prior authorizations are delayed or denied?

SamaCare conducted a recent survey of practitioners across specialties, who frequently prescribe physician-administered medications that require prior authorization. In the survey, we asked providers three key questions around the impact of prior authorizations on patient care: 

1. How does the prior authorization process impact patient care?

… of providers indicated prior authorizations have a “highly negative” or “somewhat negative” impact on patient care.

2. How do prior authorization delays or denials impact patients' likelihood to adhere to a treatment plan?

… of providers indicated prior authorization delays,  denials have a “highly negative” or “somewhat negative” impact on patients’ likelihood to adhere.

3. How does the prior authorization process impact patient outcomes?

… of providers indicated the prior authorization process has a “highly negative” or “somewhat negative” impact on patient outcomes.

Interpreting the Results 

The reported impact of prior authorization on patient care varies somewhat from specialty to specialty. For example, 100% of retina providers indicated prior authorization delays and denials negatively or somewhat negatively impact patients’ likelihood to adhere to a treatment plan, compared to 86% of providers across all specialties surveyed. Impact on patient care may differ by prognosis as well. Of rheumatologists surveyed, 100% indicated the prior authorization process negatively or somewhat negatively impacts patient outcomes. To put a human lens on this statistic, delays in treatment may impact a patient’s likelihood of long-term disability. For example, for rheumatoid arthritis, delays in treatment mean continued bone destruction and secondary soft tissue swelling. For autoimmune diseases like Lupus, the course of the disease progresses and causes additional long term damage as time passes. Depending on the disease, bones, tissue, organs all can be irreversibly damaged by delays in treatment. In one stark example supporting this point, a study of 3.6 million patients by researchers at the Cleveland Clinic showed delays in treatment for newly diagnosed cancer patients are associated with a significantly increased risk of death. 

What is clear from the survey SamaCare conducted is that specialists with experience prescribing physician-administered medications that require prior authorization overwhelmingly agree — inefficiencies in the prior authorization process hurt patients.