A study by the American Medical Association survey of 1,000 physicians found:

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  • Practices spend an average of 16 hours each week completing PAs

  • Two in five physicians have a dedicated staff who handles PAs

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  • 93% of providers report care delays

  • 34% of providers report that PA has led to a serious adverse event for a patient in their care

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Key Challenges  

  • Confusion as physicians often do not know if a service requires PA

  • Time spent calling the payer to inquire if a service requires PA

  • Resources spent calling to request a PA, faxing supporting documentation and calling back for a status of their request

  • Decision wait time can be long resulting in delay in patient care

  • Determinations are not clear

A study initiated by AHIP, the nation’s leading healthcare advocacy organization found that physician practices experience marked reduction in the administrative burden from electronic PA.

71% of physicians
Practises

Key Opportunities 

Practices can reduce the administrative burden by 69% or more through FHIR-based electronic PAs that decreases submission time between 12-17 minutes per request.

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  • Convenience of submitting PA requests at the point-of-care

  • Automation of patient eligibility and coverage determinations using FHIR-based CDS Hooks and CRD

  • Clear understanding of PA requirements and determinations

  • A fast turnaround from enabling complete patient, provider and clinical data points

  • Real-time status tracking of case history and decisions

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References

1. American Medical Association (2022). 2021 AMA prior authorization (PA)
physician survey https://www.ama-assn.org/practice-management/prior-authorization/prior-authorization-research-reports

2. RTI International Center for Health Care Advancement (February 25, 2022). Evaluation of
the Fast Prior Authorization Technology Highway Demonstration Final Report https://www.ahip.org/documents/Fast-PATH-Evaluation.pdf

3. Fierce Healthcare (January 22, 2020). Costs of prior authorizations increase for physician practices at an 'alarming' rate
https://www.fiercehealthcare.com/practices/costs-prior-authorizations-increase-for-physician-practices-at-alarming-rate

*Based on a CAQH study.