Breaking Barriers: The Impact of Prior Authorization on Healthcare Providers and Patients

At the recent AHA Annual Membership Meeting, a panel discussion was held to address the challenges faced by healthcare providers due to prior authorization policies. Moderated by Marilyn Werber Serafini, the executive director for the Health Program at the Bipartisan Policy Center, the panel included experts who shared their insights on the impact of prior authorization on patient care.

Dr. Shikha Jain from UI Health discussed how commercial insurance practices, such as prior authorization, can lead to care delays, administrative burdens, and physician burnout. Ruby Kirby, CEO of Bolivar-Camden General Hospital in Tennessee, and Kurt Barwis, president and CEO of Bristol Health in Connecticut, also shared their experiences with how prior authorization has hindered their ability to provide timely care for their patients.

Matthew Szaflarski, a Revenue Cycle Intelligence Leader at Kodiak Solutions, highlighted that initial denials for care authorization have increased by over 40% since 2020. Rachel Schwab, an assistant research professor at the Georgetown University Health Policy Institute, discussed some programs and policies that states are starting to implement to alleviate the burdens of prior authorization, such as improved transparency and extended approval lengths.

Dr. Jain emphasized the significant impact of prior authorizations on patient care, particularly for those with advanced diseases who require immediate treatment. She mentioned that a large portion of their patients at UI Health require prior authorizations for imaging or drugs and any delays in getting these authorizations can have devastating consequences.

Overall, the panel agreed that while the initial intent of prior authorization was positive