A new American Medical Association (AMA) analysis underscores why prior authorization (prior auth) has become a major operational and financial issue for healthcare providers—including behavioral health and addiction treatment organizations navigating payer friction. Citing an AMA survey of 1,000 physicians (late 2024), the report finds practices complete an average of 39 prior authorization requests per physician, per week, consuming 13 staff hours weekly. Forty percent of physicians said they employ staff who work exclusively on prior auth, and 89% reported prior auth increases physician burnout. The AMA also highlights Medicare Advantage prior auth volume and outcomes, noting that millions of requests are denied and that a high share of appealed denials are overturned—raising concerns about unnecessary administrative burden and care delays.
The article outlines reforms the AMA supports, including clinically based alternatives like “gold card” programs that exempt high-approval providers from repeated prior auth, and broader efforts to limit utilization management to true outliers. For TCIV readers, the takeaway is strategic: prior auth intensity directly impacts staffing cost, cash acceleration, denial management, patient access, and ultimately margin resilience and valuation—especially in payer-heavy modalities.