Here are nine statistics on the state of prior authorization in 2024 for spine and orthopedic providers to know:
1. Approximately nine out of 10 physicians say that prior authorization has a negative effect on patient outcomes, according to a recent AMA survey.
2. About 94% of physicians believe that prior authorizations always, often or sometimes delays patients’ accessing necessary care.
3. About 19% of physicians have had prior authorization delays lead to a serious adverse event leading to a patient being hospitalized.
4. Recent prior authorization reforms are expected to save physician practices $15 billion over the next 10 years, according to Jesse Ehrenfeld, MD, immediate past president of the American Medical Association.
5. The percentage of prior authorization denials for outpatient care claims jumped 16% in the last three years.
6. Hospitals and health systems spend an average of $19.7 billion every year pursuing reconsiderations of previously denied claims.
7. Prior authorization claim denials are, on average, more common in the inpatient setting than in the outpatient setting.
8. The American Association of Neurological Surgeons and Congress of Neurological Surgeons are lauding a bill introduced in Congress that would streamline prior authorizations for Medicare Advantage patients.
9. CMS on Jan. 17 finalized a rule to improve the prior authorization process. The new rule will require some payers to send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests.