Providers: Prior authorization needs to be better integrated with EHRs

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The prior authorization process must be improved by streamlining and standardizing procedures, and it needs better integration with electronic health record systems.

That’s the message physician groups delivered to the House Small Business Committee last week during a hearing on reducing the burden of prior authorization on small medical practices.

A major problem with prior authorization—a process by which health insurers require doctors to first obtain approval before conducting a procedure or prescribing a medication—is that it “involves varying forms, data elements and submission mechanisms that force physicians to enter unnecessary data in the EHR or perform duplicative tasks outside the clinical workflow,” contends the American College of Physicians.

“Physicians should not be required to log into a separate portal to access the software,” testified Howard Rogers, MD, on behalf of the American Academy of Dermatology Association. “A separate portal often requires the physician to re-enter the medical information or transfer the data, often taking time away that could be spent with patients.”

Rogers said AADA wants the Centers for Medicare and Medicaid Services to require plans to offer electronic prior authorization transactions that are integrated into prescribers’ EHRs.

At the same time, he commended CMS and Congress “for building on their previous efforts to require Medicare Advantage and Part D prescription drug plans to provide doctors with real-time access to drug pricing data via EHR or prescribing software, so physicians are informed of beneficiary-specific drug coverage and cost information.”

In a memo sent to members of the House Small Business Committee in advance of the hearing, Chair Nydia Velázquez (D-N.Y.) made the case for making prior authorization requirements and other formulary information electronically accessible to healthcare providers at the point of care in EHRs, as well as moving toward an industry-wide adoption of electronic prior authorization transaction based on national standards.

“Including all this information electronically in EHR systems will improve process efficiencies, reduce time to treatment and potentially result in fewer prior authorization requests because healthcare providers will have the coverage information they need when making treatment decisions,” states the memo.

John Cullen, MD, testifying on behalf of the American Academy of Family Physicians, cited a 2019 AAFP member survey that found that the highest priority for the AAFP is to reduce physicians’ administrative and regulatory burden.

“Fully 74 percent of respondents said the time spent on administrative tasks has increased since 2018,” said Cullen in his testimony. “They cite the greatest administrative burdens as those associated with electronic health record documentation, prior authorization and quality measure reporting.”

According to Cullen, prior authorization for prescription drugs was an administrative burden reported by 88 percent of respondents in the AAFP survey, while 79 percent of members indicated that prior authorization for procedures—including imaging—was a burden.

“Most troubling is that 84 percent reported that the amount of time they personally spent on administrative functions and tasks associated with patients’ care has increased in the past three years,” noted Cullen. “This is a serious problem that is getting worse.”

Rogers, who is a board-certified dermatologist and owns a small private practice, said his practice has hired two full-time staff at a cost of $120,000 per year to handle the volume of prior authorizations.

“Even with extra support staff, providers in my practice are regularly disrupted from patient care to deal with prior authorizations,” he testified. “One quarter of my office’s communications—be it phone calls, faxes, emails or notifications from EHRs or payer portals—are associated with prior authorizations.”

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