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Survey Finds Inefficiency, Care Delays and Patient Harm Caused by Prior Auth

Thu, May 12, 2022 3:07 PM | Babette Atkins (Administrator)


Findings Align With Recent AMA Survey; Provide Powerful Evidence Supporting Reform Proposal Introduced by Senator Breslin and Assemblymember McDonald  

Albany, New York — The New York State Society of Orthopaedic Surgeons (NYSSOS) today released the findings of a statewide survey of NYSSOS member orthopaedic surgery practices concerning their experiences in complying with prior authorization” requirements implemented by insurance companies.

The survey results were consistent, with nearly every respondent reporting that the requirements delayed needed care and often caused preventable harm, debilitation and pain for patients.

As healthcare utilization has increased, programs such as prior authorization have been implemented with the intention of ensuring more cost effective care. However, as these programs have proliferated, patients often experience unnecessary delays and denials for care deemed necessary by their treating physician. In addition, the indiscriminate growth of these practices has created enormous administrative burdens for orthopedic surgeons, limiting the time they have available to provide direct patient care.

Specifically, the survey found:

-    97% of respondents reported that prior authorization fails to achieve its intended purpose of reducing healthcare costs.

-    88% reported having patients abandon care due to delays associated with prior authorization.

-    94% had patients experience a deterioration of prognosis or quality of life due to prior authorization delays.

-    96% had patients experience sustained or increased pain and/or symptoms due to prior authorization delays.

-    89% had patients experience a delayed return to employment due to prior authorization delays.

-    97% say that removing prior authorization would result in more expedient care for their patients.

-    94% say that removing prior authorization would improve the quality of care their patients receive.

-    94% say the administrative burden prior authorization places on their practice has gotten worse in recent years.

The complete NYSSOS survey findings, which can be found at: https://nyssos.org/News/12777960, are very similar to the findings of a recent nationwide American Medical Association (AMA) survey concerning the same issue https://www.ama-assn.org/system/files/prior-authorization-survey.pdf.

A proposal has been introduced recently in the state Legislature to address this issue. The bill, S.8299/A.9908-A, introduced by Senator Neil Breslin (D-Albany) and Assemblymember John T. McDonald III, RPh (D-Cohoes), would create what is known as a Gold Card” program that would provide an exemption from prior authorization for health care professionals who receive at least 90 percent approval for a particular health care service over a six-month period. NYSSOS strongly supports this legislation.

Senator Neil D. Breslin, Chair of Senate Committee on Insurance, said: Current prior authorization requirements result in notable delays in medical care, interfere with continuity of care, while at the same time, impose unnecessary administrative work on health care professionals. The Gold Card bill that I am sponsoring will make sure patients receive the treatment they need in a more timely fashion, resulting in a higher quality of care.” 

Assemblymember John T. McDonald III, RPh said, "I sponsor the Gold Card bill to help streamline the prior authorization process and ease the burdens that patients face when accessing care. When someone is facing a medical issue, we want to make it easier for the patients to receive necessary treatment and for providers to provide the care needed. I believe this is a commonsense measure that would address some of the challenges that too many face, and builds toward a better healthcare system."

A similar proposal was recently enacted into law in Texas. https://www.ama-assn.org/practice-management/sustainability/new-physician-gold-card-law-will-cut-prior-authorization-delays

NYSSOS President Dr. John DiPreta said: It s time that we confront a growing problem that is present in virtually every treatment room in our state. The proliferation of prior authorization activities is causing unnecessary delays in care, harming patients and driving avoidable administrative burdens for practitioners. We are calling on state leaders to end the unnecessary patient suffering and debilitation that is directly caused by current prior authorization practices, and we are hopeful that the solution proposed by Senator Breslin and Assemblymember McDonald quickly makes its way through the Legislature and is delivered to the Governor s desk.



About NYSSOS: Representing more than 800 orthopaedists across New York State, NYSSOS advocates for orthopaedic surgeons, patients and musculoskeletal health in New York State. NYSSOS is the orthopaedic community’s primary source of information and expertise concerning: legislative/regulatory advocacy (local, state and federal levels); practice trends and change; leadership training for national, state, and local issues and opportunities; assistance with establishing and maintaining a practice; and familiarity with state practice guidelines impacting the profession and patient care. Learn more at www.nyssos.org

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