According to American Medical Association (AMA), the DME Prior authorization burden was high or extremely high for 85% of physicians in 2020, and payer policy improvements during the pandemic were minimal. Despite addressing a rise of confirmed pandemic cases this winter, most physicians still faced a high DME PA burden, according to the American Medical Association (AMA).
What does the American Medical Association (AMA) Survey suggest?
In a poll of 1,000 practicing physicians conducted between November 23, 2020, and December 14, 2020, the American Medical Association discovered that 85% of physicians described the burden of prior authorization as high or extremely high last year. According to the report, practices executed 40 DME prior authorizations per physician every week on average. And, on average, those DME prior authorizations took two business days, or 16 hours, each week.
The burden of DME prior permission was marginally lower than in the previous year’s poll, when 85% of physicians classified it as high or extremely high. Practices also had an average of 33 prior authorizations per physician per week, with a 14.4-hour turnaround time.
DME prior authorization burden
Despite the minor decrease in burden, the DME prior authorization work in 2020 was completed against the backdrop of a global public health emergency, according to the AMA. The majority of physicians felt that DME PA policy adjustments implemented during the pandemic had little reach and had a diminutive long-term impact. By the end of 2020, only 1% of physicians encountered lightened restrictions and had continued to perceive a reduced DME prior authorization burden. Meanwhile, the remaining 14% of physicians were unaware.
Why Reform is required?
According to the AMA, the findings show that DME prior authorization reform is still needed. By the end of 2020, the U.S. health system was pressured by record numbers of new pandemic cases every week. The AMA discovered that most physicians were confronting rigorous authorization obstacles that delayed patients’ access to the required care.
Around 94% of doctors confirmed at least some service delays as a result of prior authorizations. DME Prior authorizations, according to 79% of physicians, can sometimes lead to treatment discontinuation. Even more concerning, 30% of physicians polled said that DME prior authorization had resulted in a significant adverse event for a patient under their care. According to 21% of these clinicians, DME PA has resulted in hospitalization, while 18% say the requirement has resulted in a life-threatening occurrence or necessitated intervention to avert lasting impairment or harm.
America’s Health Insurance Plans (AHIP)
However, according to a survey performed by America’s Health Insurance Plans (AHIP) last year, payers feel DME prior authorizations have a mainly beneficial influence. DME PA was found by the majority of payers to be an evidence-based method for ensuring the quality of care, affordability, and safety.
AHIP recently released survey data indicating that electronic DME PA may increase the quality of care while reducing the administrative load on providers. 6 out of 10 physicians who utilized DME PA on a regular basis felt that electronic DME prior authorization made it easier to determine if they needed to get DME prior authorization.
Key takeaways
Almost the same proportion of physicians who were well-versed in DME prior authorizations indicated that the electronic DME prior authorization criteria were easier to understand. More than half of them said the DME prior authorization decision was easier to see. Adoption of electronic DME PA is one of the actions specified in the consensus statement endorsed by key payers.
