Easing time spent on prior authorization requires industry-wide adoption of electronic transactions

AMA Director Heather McComas and Tyler Scheid, senior policy analyst, will speak at HIMSS19.

Prior authorization is still a time-consuming, fax and phone call laden process that frustrates providers because the delay can put patients at risk.

Based on 2017 data, the average prior authorization takes at least one business day and can take up to three business days.

"There are a lot of administrative burdens, but this one affects care," said American Medical Association Director Heather McComas, PharmD.

If prior authorization could be done at the point-of-care through the EHR, the time could be cut down to less than one minute, according to Tyler Scheid, senior policy analyst for the AMA.

At HIMSS19, McComas and Scheid will discuss what's being done to get there and what still needs to happen.

The AMA has been involved in reform initiatives for at least two years, McComas said. In January 2018, the American Medical Association, the American Hospital Association, America's Health Insurance Plans and three other healthcare organizations, released a consensus statement on how to improve prior authorization. Others have since signed on.

One big point of agreement is that the information must be electronically accessible to healthcare providers in the EHR.

This requires standardization, integration and alignment of purpose. It depends on everyone agreeing to right timeline, to get the final requirement information from the health plan, Scheid said.

"Everyone has to agree, this is the way we're going to do it. We have a long way to go," McComas said. "The pieces are there."

The hold-ups are numerous. Prior authorization is designed to put checks in place from over-prescribing. Clinical documentation often requires questions asked and answered in numerous phone calls. The requirements for medical procedures are complicated.

There's also no standardized system for the exchange of clinical data and there's no rule for electronic attachments. Physicians need real time drug benefit and patient pay information that is not widely available as yet.

The secure exchange of information through blockchain and other technology is also not yet widespread.

McComas and Scheid will discuss "Leveraging Technology to Improve Prior Authorization" from 2:30-3:30 p.m., Wednesday, February 13, room 204A, at the Orange County Convention Center, Orlando, Florida.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com