AMA Survey Highlights Growing Burden of Prior Authorization on Physicians, Patients

The prior authorization (PA) process continues to impact patient outcomes and fuel physician burnout, leading to unnecessary spending and additional office visits, according to the 2024 American Medical Association (AMA) PA physician survey.1

Of the surveyed physicians, 93% reported that prior authorization (PA) delays patient care, and 89% said it contributes to burnout. | Image Credit: piter2121 - stock.adobe.com

Although health plans and pharmacy benefit managers claim PA programs are necessary to control costs, physicians and other providers often find them to be time-consuming barriers to delivering essential treatment. Therefore, the AMA conducts an annual nationwide survey to assess the evolving impact PA has on patients, physicians, and overall health care spending.

The 43-question, web-based survey was administered in December 2024 among 1000 practicing physicians drawn from a Medscape panel. Of the sample, 40% were primary care physicians, and 60% were specialists. The sample was screened to confirm that all participating physicians currently practice in the US, provide 20 or more hours of patient care per week, and complete PAs during a typical week.

PA's Impact on Patient Care, Physician Burnout, and Health Care Costs

Of the surveyed physicians, 93% reported that PA causes patient care delays, with 82% stating it can sometimes lead to treatment abandonment. Additionally, 94% said that PA has a somewhat or significantly negative impact on patient clinical outcomes, with more than 1 in 4 (29%) reporting that it caused a serious adverse event for a patient in their care.

PA also significantly increases costs to the health care system, as 88% of physicians reported higher overall resource utilization. Because of PA requirements and delays, patients often endure ineffective initial treatments, require additional office visits, seek immediate or emergency care, or face hospitalization.

Beyond driving up health care resource utilization, 80% of physicians said PA delays or denials sometimes force patients to pay out of pocket for medication. Employers also feel the impact, as 58% of physicians reported that PA negatively impacts patient job performance; PA leads patients to miss work due to rescheduled appointments or prolonged illness while awaiting care.

As for physicians, they complete an average of 39 PAs per week, spending approximately 13 hours on the process. As a result, 89% report that PA somewhat or significantly contributes to burnout.

Nearly 1 in 3 (31%) physicians said that PAs are often or always denied, with 1 in 5 (20%) physicians always appealing an adverse PA decision. However, 67% of those who do not appeal believe it would be unsuccessful based on past experience.

Challenges in Reducing PA Burdens and the Role of AI

PA continues to create challenges for patients and physicians despite major health plans promising the opposite. In 2023, United Healthcare and Cigna announced reductions in the number of services that require PA. However, only 16% of physicians who work with United Healthcare and 16% who work with Cigna reported that these changes reduced the number of PAs they completed.

Similarly, physicians reported consistently high PA burdens across major health plans despite commitments to reduce administrative workload and improve access to safe care made in the 2018 “Consensus Statement on Improving the Prior Authorization Process” by the AMA, American Hospital Association, American Pharmacists Association, Medical Group Management Association, America’s Health Insurance Plans, and Blue Cross Blue Shield Association.

As health plans explore ways to improve PA, 61% of physicians expressed concerns that augmented intelligence (AI) either increases or will increase PA denial rates. AI tools have been accused of producing higher denial rates, up to 16 times higher in some cases.2 AMA President Bruce A. Scott, MD, said in a press release that insurers using AI-enabled tools to automatically deny PA requests “is not the reform of PA physicians and patients are calling for.”3

“Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care,” Scott said. “Medical decisions must be made by physicians and their patients without interference from unregulated and unsupervised AI technology.”

References

1. 2024 AMA prior authorization physician survey. AMA. Accessed February 24, 2025. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
2. Physicians concerned AI increases prior authorization denials. News release. AMA; February 24, 2025. Accessed February 24, 2025. https://www.ama-assn.org/press-center/press-releases/physicians-concerned-ai-increases-prior-authorization-denials
3. Physicians concerned AI increases prior authorization denials. News release. AMA. February 24, 2025. Accessed February 24, 2025. https://www.ama-assn.org/press-center/press-releases/physicians-concerned-ai-increases-prior-authorization-denials