A recent survey conducted by the American Medical Association (AMA) has revealed significant concerns among physicians regarding the use of artificial intelligence (AI) in healthcare, particularly related to AI prior authorization denials. The survey, which included 1,000 practicing primary care physicians and specialists in the United States, highlights the increasing challenges that AI poses to both healthcare providers and patients.
Increasing Prior Authorization Denials Due to AI:
One of the primary concerns expressed by most physicians surveyed is that the use of AI by health insurance companies is leading to a rise in AI prior authorization denials. In fact, 61% of respondents believe that AI has increased or will increase denial rates. The physicians worry that automated decision-making systems, often used by insurers, result in batch denials with minimal human oversight, leading to delays in care and potentially harmful consequences for patients.
According to AMA President, using AI-enabled tools to automatically deny care is not the type of reform physicians and patients seek. He emphasized that medical decisions should be made by healthcare professionals rather than by unregulated AI technologies that place unnecessary barriers between patients and the care they need.
Delays in Care and Patient Abandonment:
The survey highlights that 93% of physicians believe prior authorization delays patient care, while 82% report that patients may abandon treatment due to these delays. Alarmingly, 29% of respondents noted that prior authorization has led to serious adverse events, including:
- Hospitalization (23%)
- Life-threatening events or interventions to prevent permanent damage (18%)
- Permanent damage, disability, or death (8%)
These statistics underscore the real-world impact of insurance companies leveraging AI in the prior authorization process without adequate oversight.
Evidence-Based Concerns:
Physicians also expressed doubts about the evidence basis of prior authorization criteria. Thirty-one percent stated that the criteria are rarely or never evidence-based, and the same percentage reported that prior authorization requests are often or always denied, regardless of clinical justification.
Physician Burnout and Healthcare Costs:
The survey also sheds light on how prior authorization contributes to physician burnout and increased healthcare costs. Nearly 89% of respondents said that managing prior authorization increases burnout, with physicians and their staff spending an average of 13 hours per week on such requests. Additionally, practices complete approximately 39 prior authorization requests per week.
Furthermore, 88% of physicians noted that prior authorization often leads to higher healthcare utilization due to:
- Ineffective initial treatment (77%)
- Additional office visits (73%)
- Immediate care or emergency department visits (47%)
- Hospitalizations (33%)
Financial Burdens on Patients:
Prior authorization requirements also affect patients financially. Around 80% of physicians reported that patients sometimes have to pay out of pocket for medications when prior authorization is denied or delayed. This financial strain is exacerbated by AI prior authorization denials, which can introduce further complexities and potential for errors in the decision-making process, resulting in a significant financial burden, particularly for those with chronic conditions requiring ongoing treatment
Minimal Impact from Policy Changes:
The survey also indicates that recent changes made by UnitedHealthcare and Cigna in 2023 have not significantly alleviated the burden of prior authorization. Only 16% of physicians working with each company reported a reduction in the number of prior authorizations required.
A Call for Balanced Use of AI:
The findings of this survey emphasize the need for careful consideration of AI implementation in healthcare. While AI has the potential to improve efficiency, the specific concern of AI prior authorization denials highlights how automating these processes without adequate human oversight can compromise patient care and contribute to physician burnout. There is a pressing need for regulatory frameworks that ensure AI-driven decisions, particularly regarding AI prior authorization denials, are clinically sound and patient-centered.