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

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.