For providers, the term “prior authorization” (PA) often evokes feelings of extreme frustration. Prior authorization is used to determine if certain drugs, such as high cost medications used for cancer treatment, are covered by a patient’s health insurer and able to be prescribed. Although designed to control costs, providers have grown extremely aggravated with the process, spending five to eight hours per week handling these requests when manual processing is the only option.i
Many EHR software systems have incorporated electronic prior authorization capabilities, but the functionality may not yet be a standard option, despite vendor acknowledgment that it can improve clinician workflow and quality of care. Providers noted three key benefits of having access to electronic prior authorization functionality:
- 1. More efficient workflow
- 2. Time savings
- 3. Reduced administrative burden
When it comes to the inefficiencies of manual PA processing, the survey and other existing research indicated that:
- 80% of prior authorization requests require extra work, rework or phone/fax follow upsii
- 30% of a practice’s incoming calls are from patients looking for their prescriptionsiii
- 5-8 hours of physician and support staff time are spent each week on manual prior authorizations and activities related to PA processing each weekiv
Manual processing of PAs is archaic, and physicians and their clinical support staff recognize that making the process electronic is becoming increasingly important and necessary. Of providers surveyed:
- 83% said that adding electronic prior authorization is a priorityv
- 64% agree or strongly agree that their EHR vendor should provide the functionality to help alleviate the pain points of prior authorizationvi
Once implemented, the impact that electronic prior authorization has on a provider’s workflow is truly game changing. Dr. Barry Wendt, CMIO for St. Elizabeth Healthcare, noted that “it's paperless, it's on the EMR, it's documented on the EMR, and it's a much, much quicker turnaround than what we had before.” Tanya Beecher, an RN at St. Elizabeth’s, also recognized just how much having the solution has changed the PA process for the better. “It's so fast. It's so easy to complete PAs now. You can just open the encounter and see everything you need right in front of you,” she said.
EHR vendors recognize the value of having an electronic PA solution as well, with 88 percent citing that they are aware of the importance of this functionality to their customers. Similarly, 86 percent recognize that electronic PA functionality is something that their customers expect their technology to provide in order to help them manage the process.vii
But what about the impact on patients? 66 percent of physicians say that it can take two or more days, on average, for patients to get their medication when a prior authorization is involved,viii and 40 percent of prescriptions are abandoned at the pharmacy due to delays.ix These delays mean decreased medication adherence and ultimately affect care quality, both of which can be improved when PAs are processed electronically.
The inefficiency of manual PA processing translates into hours of wasted time, contributes to workflow inefficiency and impedes a practice’s ability to deliver optimal and timely care. The time to enable electronic prior authorization is now. The pain is real, but so is the solution. For more information on the pain points of PA and benefits of an electronic solution, please see our infographic below.
Providers: Are you ready for electronic prior authorization? Just follow these easy steps and you’re on your way!
- Step 1: Ask your EHR when they plan to offer an integrated electronic prior authorization solution.
- Step 2: Make sure their solution is fully automated, instead of a fax or web portal outside of your regular workflow.
- Step 3: Insist that your EHR provide a truly automated electronic prior authorization solution that is integrated into your workflow.
You can also visit our online information kit for more information.
i Surescripts Prior Authorization Survey, 2015.
ii“Electronic Prior Authorization and Its Potential Impact on Healthcare.” Center for Health Transformation. http://wayne-oliver.com/wp-content/uploads/2012/05/Electronic-Prior-Authorization-White-Paper-Final-Mar-161.pdf
iii Backer, Leigh Ann. “Strategies for Better Patient Flow and Cycle Time.” Family Practice Management, 2002 Jun; 9(6):45-50 http://www.aafp.org/fpm/2002/0600/p45.html
iv Surescripts Prior Authorization Survey, 2015.
v Surescripts Prior Authorization Survey, 2015.
vi Surescripts Prior Authorization Survey, 2015.
vii Surescripts Prior Authorization Survey, 2015.
vii] Surescripts Prior Authorization Survey, 2015.
ix Journal of Managed Care Pharmacy. Vol. 15, No. 7, September 2009. http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=8199