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Impact of Insurance Prior Authorizations on Patient Outcomes

Impact of Insurance Prior Authorizations on Patient Outcomes

1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?

We are interested in understanding the impact of insurance prior authorizations (and associated delays) on outcomes, for treatments and diagnostic tests on patient care and costs. Many prior authorizations for musculoskeletal MRI, for example, are ultimately approved, but delay care for patients and add extra administrative cost to the health care for both physician practices and the insurance companies. Similarly, inpatient rehabilitation facility (IRF) admissions are frequently delayed due to need for prior authorization, despite such patients meeting all medical criteria for IRF admission. These delays have several unintended consequences including a) poorer outcomes for patients subject to the delay, b) adverse impact on acute care inpatient discharge/flow resulting in unnecessary prolonged acute-care length of stay.

2. Why are you struggling with this issue?

Prior authorization is a vast and increasingly important issue in health care delivery. Prior authorization adds extra administrative burden and delays patient care. The associated delays can have a detrimental impact on patient outcomes (delay in diagnosis and treatment) and physician practices (e.g. increased time spent resolving prior authorization issues).

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

Understanding the full positive and negative impact of prior authorizations to the health care system may be helpful to help payors choose particular types of prior authorization that are most appropriate and least harmful to patient care.

4. When do you need the evidence report?

[No date given]

5. What will you do with the evidence report?

An evidence report could be disseminated to health care providers, policy makers, and payors to help inform important changes needed to the implementation of prior authorization to improve patient care (possibly ending certain prior authorizations, as appropriate).

Supporting Document

Title or short description: Impact of insurance prior authorizations (and associated delays) on outcomes, for treatments and diagnostic tests on patient

(Optional) About You

What is your role or perspective? Medical Specialty Society

If you are you making a suggestion on behalf of an organization, please state the name of the organization: American Academy of Physical Medicine and Rehabilitation

May we contact you if we have questions about your nomination? Yes

Page last reviewed February 2021
Page originally created July 2020

Internet Citation: Impact of Insurance Prior Authorizations on Patient Outcomes. Content last reviewed February 2021. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/get-involved/nominated-topics/prior-authorizations

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