I’m not alone in my assessment of the prior authorization (PA) process as a significant burden for physician practices: according to a 2017 American Medical Association (AMA) Prior Authorization Physician Survey,1 a medical practice completes an average of 29.1 PA requests per physician per week, which takes an average of 14.6 hours to process, or nearly two business days.
The PA burden is currently a reasonable one for my staff and I, but that wasn’t always the case. When we handled PAs ourselves – specifically, I handled many submissions personally – the process had a significant, negative impact on practice management and on patient care. No matter how well I kept up with the forms specific to each patient’s insurance plan, their condition, and the medication brand, I’d often find myself facing a denial and so having to get on the phone with the plan. This invariably meant at least 45 minutes on hold – sometimes that long just to reach a person, and not always the right person at that, and with no guarantee I’d be able to turn the denial around. Critical delays were common, and absolutely impacted patient care – for example, I often prescribe Restasis for chronic dry eye, for which there really isn’t an equal substitute, and which requires a PA under most plans.
When PAs are denied, this means my patients aren’t receiving the medication I’ve deemed best suited to treat their condition, which in turn impacts clinical outcomes. I’ve since changed how my practice handles PAs – I now submit via the PARx Solutions portal, knowing I’ll be provided with the right form and that most importantly, as a full service provider the PARx team will work with my patients’ plans on my practice’s behalf. Unlike PA services that provide just the forms, their team of qualified healthcare professionals call the plans (and wait out the inevitable hold times), work with my staff to provide any additional information that is required, and overall greatly increase the potential for approvals. Submissions take an average of 5 minutes to complete, and we usually have a final answer from the plan within 48 hours.
My practice management has improved, my patient care has improved (both in terms of being better able to get the medications I prescribe to my patients, and in the additional time I now have to spend with my patients), and overall, I’d recommend this approach to any medical practice.
Dr. Jeffrey Williams is an Optometrist with Sound Vision Care, Inc. of Long Island, NY. A graduate of The Ohio State University, he is Board Certified by The American Board of Optometry and The National Board of Optometric Examiners.
- 2017 AMA Prior Authorization Physician Survey. 2018. Chicago: American Medical Association. Accessed April 16, 2018 at https://www.ama-assn.org/sites/default/files/media-browser/public/arc/prior-auth-2017.pdf.