Many physicians fear the health insurance industry’s use of unregulated artificial intelligence (AI) automation and predictive technologies will increasingly override good medical judgment and systematically deny patients coverage for necessary medical care. According to a new survey from the American Medical Association (AMA), 3 in 5 physicians (61%) are concerned that health plans’ use of AI is increasing prior authorization denials, exacerbating avoidable patient harms, and escalating unnecessary waste now and into the future.
The annual prior authorization survey included responses from 1,000 practicing physicians — 400 primary care and 600 specialists — from a wide range of practice settings.
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Burdensome prior authorization requirements that conflict with evidence-based clinical practices and create hurdles to patient access to safe, timely, and affordable treatment have been a major impediment to patient care for decades, AMA officials noted. More recently, health insurers have turned to AI decision-making tools that generate prior authorization decisions with little or no human review. These AI tools have been accused of producing exceptionally high rates of care denial, they added.
“Using AI-enabled tools to automatically deny more and more needed care is not the reform of prior authorization physicians and patients are calling for,” AMA President Bruce A. Scott said in a statement. “Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care. Medical decisions must be made by physicians and their patients without interference from unregulated and unsupervised AI technology.”
To that end, the AMA is advocating for AI to augment decision-making and be referred to as “augmented intelligence” — not used to remove humans from patient care, coverage, or treatment.
Notably, the AMA’s Augmented Intelligence Research released in February found that nearly half of all physicians (49%) ranked oversight of payers’ use of AI in medical necessity determinations among the top three priorities for regulatory action. Moreover, recently passed AMA policy identifies significant concerns with insurer use of AI.
Here are some other highlights of the survey, which can be accessed here.
- Denial trend: Three-quarters of physicians (75%) reported the number of prior authorization denials has increased somewhat or significantly over the last five years.
- Patient harm: More than one in four physicians (29%) reported that prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death.
- Poor outcomes: More than 9 in 10 physicians (94%) reported that prior authorization has a negative impact on patient clinical outcomes.
- Delayed care: More than 9 in 10 physicians (93%) reported that prior authorization delays access to necessary care.
- Added burden: Physicians reported completing an average of 39 prior authorizations per week, and nearly 1 in 3 physicians (31%) reported that prior authorization requests are often or always denied.
- Physician burnout: Nearly 9 in 10 physicians (89%) reported that prior authorization somewhat or significantly increases physician burnout.
- Wasted health resources: More than 4 in 5 physicians (88%) reported that prior authorization requirements lead to higher overall utilization of health care resources, resulting in unnecessary waste rather than cost savings.
In the wake of these survey results, the AMA says it continues to “right-size” prior authorization programs so that physicians can focus on managing patient care rather than administrative burdens.
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