Research Study: Insurance Barriers Blocking Access to Healthcare

Significant barriers to patient care implemented by the health insurance industry are difficult to navigate, have a negative impact on patient care and drive up the administrative costs of healthcare, according to a statewide survey of Georgia physician assistants.  The survey, which was released yesterday by the Georgia Association of Physician Assistants (GAPA), also indicated that most physician assistants (PAs) are proactively taking steps to help address the problems that plague the system, and feel there is a legislative role that can contribute to a solution.


According to the survey, a nearly universal 99 percent of PAs stated they have had to change the way they treat a patient as a result of restrictions imposed by an insurance company. An overwhelming majority, 94 percent, feels that health plans frequently or occasionally delay or deny diagnostic testing or prescription medications for their patients.

Not surprisingly, 93 percent of those surveyed stated they felt insurance requirements such as prior authorizations, pre-certifications, and step therapy protocols had some degree of a negative effect on their ability to treat patients.

"The lessons learned from this report are resounding, in that nearly all the physician assistants that responded to the survey cited major insurance hurdles they had to jump over before being able to provide the care they deemed appropriate for their patients," said Mary Vacala, ATC, PA-C, MSPAS, DFAAPA, and 2010-11 president of the Georgia Association of Physician Assistants. "Some cited several phone calls taking 45 minutes with an insurance company.  Others noted that patients are forced to go without medication until the insurance company would approve the treatment already prescribed by the healthcare professional."
One-in-five respondents stated they or their staffs are required to interact with an insurance provider to obtain approval for a prescribed course of treatment or to determine the insurer criteria for prior authorization or step therapy protocols an alarming 150 times or more per month. Approximately one-in-five said the number was 61-100 and more than one-in-four stated the number of interactions as 21-60.

"There are more than 2,000 physician assistants across the state of Georgia, and so many are using technology such as electronic medical records and e-prescribing, to promote better, more coordinated care," concluded Vacala.  "As these technologies continue to be developed, the Georgia General Assembly should take steps requiring that patient formulary information be more transparent and that there be a uniform electronic process for obtaining medication approval.  By taking simple steps, we will save significant time and resources while also having a healthier patient population in Georgia."

Source: Georgia Association of Physician Assistants