The Impact of Prior Authorization Requirements on Primary Care Physicians' Offices: Report of Two Parallel Network Studies

Journal of the American Board of Family Medicine, Vol. 26, pp. 93-95, January-February 2013

Posted: 18 Jan 2013

See all articles by Christopher P. Morley

Christopher P. Morley

SUNY Upstate Medical University, Department of Family Medicine

David Badolato

Independent

John Hickner

Independent

John W. Epling

Independent

Date Written: January 2013

Abstract

Introduction: US primary care physicians and their office staff have experienced large increases in time-consuming requirements for prior authorization (PA) of tests, medications, and other clinical services in recent years. This report presents results of 2 similar studies in which physicians and office staff self observed and reported the amount of time spent on PA activities.

Methods: Physicians and office staff from 12 primary care offices in northeastern United States recorded request type, reporter role, and time spent for each PA event at the time of the PA activity. Costs were estimated using salary data from the US Bureau of Labor Statistics (study 1) and from Salary.com (study 2). Time and costs were estimated for the practices in each study.

Results: The mean annual projected cost per full-time equivalent physician for PA activities ranged from $2,161 (study 1) to $3,430 (study 2). Using self-reporting at the time of the event, we found that preauthorization is a measurable burden on physician and staff time.

Conclusions: Further studies that include cost-benefit analyses, estimates of opportunity costs and costs of delayed testing and treatment, as well as the “hassle factor” for patients and physicians, are warranted.

Keywords: Prior Authorization, Primary Care, Insurance

Suggested Citation

Morley, Christopher P. and Badolato, David and Hickner, John and Epling, John W., The Impact of Prior Authorization Requirements on Primary Care Physicians' Offices: Report of Two Parallel Network Studies (January 2013). Journal of the American Board of Family Medicine, Vol. 26, pp. 93-95, January-February 2013 . Available at SSRN: https://ssrn.com/abstract=2201875

Christopher P. Morley (Contact Author)

SUNY Upstate Medical University, Department of Family Medicine ( email )

Syracuse, NY 13210
United States

HOME PAGE: http://www.upstate.edu/fmed/research.php

David Badolato

Independent ( email )

John Hickner

Independent ( email )

John W. Epling

Independent ( email )

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