Every practice has that one weekly ritual that feels less like healthcare and more like paperwork triage. Staff huddled around a computer, tracking down medical records, fax confirmations, and payer phone numbers to secure approval for a medication, imaging scan, or procedure.
For providers and front-desk teams already stretched thin, prior authorizations (PAs) are a recurrent challenge that steals clinician time, delays care, and chips away at patient trust.
This article breaks down the problem clearly: why PAs have ballooned into a system-wide burden, where common thinking about them misses the mark, what credible data shows about the downstream effects, and practical ways clinics can reduce the pain without sacrificing compliance.
Throughout, I’ll point to legitimate studies and industry reports so you can cite evidence when you make the case inside your clinic or to leadership.
What Many Clinics Believe: PAs are Unchangeable
“PAs are annoying, but they’re how payers control costs. We have to fill them out; it’s just part of running a practice.”
This is a typical reaction inside clinics when we talk about Prior Authorizations. That response is understandable as it accepts PAs as immutable friction and treats the work as an internal cost of doing business.
That’s a misconception with real consequences. Treating PAs as an unavoidable administrative line item normalizes inefficient workflows and prevents clinics from asking the right questions such as: Are we spending staff time on low-value PAs? Are patients being harmed by delays? Are there ways to reduce volume, automate approvals, or reallocate human effort to higher-value tasks?
Framing PAs solely as “payers’ business” also misses a key point that many of the processes driving the burden are operational, not clinical. In other words, better front-office processes, clearer documentation practices, smarter use of technology, and strategic payer relationships can reduce PA volume and turnaround time, and that benefits both patients and clinic operations.
Data Reveals that it’s a Measurable Problem
Here are the most important, evidence-backed points clinics should know.
- According to the American Medical Association, practices handle dozens of PAs per physician each week. Multiple surveys and national studies report that physicians’ practices complete, on average, around 40–45 prior authorizations per physician per week and staff spend double-digit hours weekly just on these tasks. This is not a small, occasional burden; it’s a predictable, recurring workload.
- PAs delay care and contribute to abandonment. Large physician surveys find that the vast majority of clinicians report PAs delay patient care; many also report patients abandoning recommended treatments because of the authorization maze. One national survey reported that prior authorizations caused care delays for 93% of physicians and that many patients either abandoned care or experienced treatment interruptions.
- In one study of PubMed Central, we can infer that a time spent doesn’t always increase approval rates. Studies examining who completes PAs and how much time they consume show that advanced practice providers and administrative staff spend significant time preparing requests, often without measurable improvement in approval outcomes. That suggests the problem is not only effort, but process design and payer variability.
- Administrative burden correlates with burnout and adverse events. Surveys and analyses link heavy PA workloads to clinician burnout, lower job satisfaction, and, in some reports, even patient harm when urgent care is delayed. National organizations and peer-reviewed papers highlight cases where PA-related delays contributed to serious adverse events, underscoring this as a systems issue with clinical stakes.
- Reuters.com mentioned in one of their articles that regulators, major provider associations, and even some large payers are exploring reforms (including electronic PA standards, gold-card exemptions, and programmatic reductions). Recent payer announcements to reduce PA requirements for certain services show the industry recognizes the problem but adoption is uneven and timelines are long.
In summary, these data points tell a clear story: prior authorizations are widespread, time-consuming, consequential for patients, and not immutable. There are levers clinics can pull.
Why Many Clinics are Losing the Battle
Before outlining solutions, it helps to understand why many clinics struggle.
- Fragmented payer rules. According to the Medical Group Management Association (MGMA), each insurer often has different criteria, forms, and required attachments. That variability forces staff to treat each PA as a new problem rather than an instance of a standardized process.
- Manual, reactive workflows. When authorizations are handled reactively (only when the scheduler or clinician discovers a requirement), the clinic rushes to compile records under time pressure, increasing errors and resubmissions.
- Underinvestment in the right roles and tools. Clinics often assign PAs to whoever has bandwidth rather than a trained specialist or an electronic prior authorization (ePA) workflow, which reduces efficiency and increases time per request. Studies show teams spend substantial hours without net gains to approval rates.
- Siloed documentation and poor submission quality. Missing or poorly organized clinical documentation sends requests back to the clinic or results in denials — which means more work and longer delays.
- Lack of strategic payer management. Clinics rarely analyze PA volumes by payer or service line to identify high-yield targets for process change or contract negotiation.
Each of these failure modes is addressable. The next section explains practical, evidence-based approaches clinics can adopt and what the literature and industry guidance recommend.
Evidence-based Solutions that Clinics can Start Integrating Now
The approaches below are grouped from quick operational wins to strategic investments. For each, I’ll note the rationale and, where available, cite supporting studies or industry guidance.
- Triage and standardize: create PA playbooks for high-volume requests - Identify the top 10 services/medications that generate PAs in your clinic (e.g., specific imaging, infertility medications or procedures for fertility clinics, certain behavioral health medications, or durable medical equipment). For each, create a “pack” with pre-filled documentation, standard justification language, and checklists for required attachments. The theory of “work standardization” is straightforward: when staff follow a templated workflow, time per request drops and approval quality rises.
Why it works: Payer variability is high, but many requests are repetitive. Standardization reduces rework and is endorsed by operational best practices. MGMA and other practice-management bodies recommend consistent submission templates and playbooks as a core mitigation strategy.
- Measure then prioritize - Track PA volume, turnaround time, approval/denial rates, and staff hours by payer and service line. Even simple spreadsheets can reveal high-impact opportunities. For example, a payer that generates a disproportionate share of denials or a procedure line that takes excessive staff hours.
Why it works: Data lets you prioritize. Based on the journal article published by Oxford University Press, if a single payer causes 40% of denials, targeted negotiation (or escalation) with that payer is more effective than generalized fixes. Industry research stresses the importance of measuring administrative burden before investing in automation.
- Invest in trained specialists or a centralized PA team - Clinics that routinize PAs into a centralized or dedicated team see better throughput and fewer resubmissions. Specialized staff develop payer knowledge, create efficient templates, and handle appeals more effectively than ad hoc handlers.
Why it works: Studies show significant staff time is consumed by PAs but not always with improved results when done by non-specialists. Centralization professionalizes the function and supports performance tracking.
-
Improve upfront clinical documentation and decision support - Embedding clinical decision-support templates in the EHR that capture payer-specific justification items at the point of care reduces the back-and-forth later.
For example, a fertility clinic could capture required infertility workups or prior treatment history in structured fields so the PA packet is automatically populated.
Why it works: Higher-quality, payer-targeted submissions have higher approval rates and lower resubmission rates. Studies connecting documentation quality to approval outcomes support this operational investment.
- Build payer relationships and negotiate smarter - Use your PA data to engage payers strategically. Ask for a “gold-card” program that exempts your clinic for specific low-risk services or a process improvement agreement that commits to faster responses. Where possible, request transparent criteria or peer review options that involve appropriately credentialed reviewers.
Why it works: Payer programs and voluntary reductions are happening (some payers have publicly announced reductions in PA requirements for certain services). A clinic armed with data can often secure operational concessions.
- Use escalation and appeal workflows - Create a fast escalation pathway for urgent clinical cases. Studies and surveys show delays lead to adverse outcomes in some scenarios; having a documented, time-bound escalation workflow reduces the chance that clinically urgent care languishes. Include clinician signoffs for urgent appeals and identify payer escalation contacts in advance.
Why it works: Urgent clinical needs require a different cadence. Preparing escalation templates and contacts avoids last-minute scramble and reduces clinical risk.
-
Consider strategic partnerships with trusted companies - For clinics that prefer not to build an internal PA team, partnering with a vendor or a specialized virtual assistant team can be an efficient alternative. The key is to select a partner with healthcare compliance experience, HITRUST/HIPAA controls, and demonstrated outcomes (reduced turnaround times, higher approval rates).
Why it works: Getting a reliable partner can convert a fixed internal cost into a managed service with demonstrated SLAs. Many clinics find this is a cost-effective way to regain clinician time for revenue-generating activities. (Companies such as Global Medical Virtual Assistants support clinics implementing these models).
The Ethical and Patient Angle: Why it’s Important Beyond Workflow
Prior authorizations are often framed as fiscal controls. But when approvals become a barrier to timely care, clinics are left balancing compliance with duty of care. The evidence that PAs lead to delays, care abandonment, and, in some cases, harm should motivate operations leaders to act — not only to improve margins or provider satisfaction, but to protect patients.
Conservative, pragmatic operational changes (better documentation, targeted automation, centralized teams, payer negotiation) reduce the risk of delayed care while keeping clinics compliant with payer rules. That’s a responsible, patient-forward approach.
Final Thoughts
Prior authorizations are a growing, measurable burden, but they’re not an unsolvable problem. The path forward isn’t a single “magic” technology or a legislative fix; it’s a combination of measurement, process design, appropriate technology (like ePA where available), and smart partnerships. Clinics that treat PAs as a solvable operations problem can reclaim hours of staff time, reduce clinician burnout, speed patient access to needed services, and improve financial predictability.
If you’d like help turning these ideas into an operational plan tailored to your clinic, start by gathering two pieces of data: (1) your top 10 PA-generating services/medications, and (2) the total weekly staff hours spent on PAs.
With those, you can prioritize the highest-impact interventions and decide whether to centralize, automate, or partner. GMVA helps clinics build those playbooks and manage prior authorization workflows with trained, HIPAA-compliant clinical operations teams without selling you a “one size fits all” box.