AMA president warns prior authorization hurting patients, driving burnout and practice closures

This major legislative effort in Congress, House Bill 3514, was recently reintroduced and aims to increase transparency and streamline approvals for medically necessary care covered by Medicare Advantage plans. These Medicare plans are outsourced for management by private insurance companies, but often come with a large number of prior authorization requirements. Insurance companies say these are needed to ensure the care delivered is medically necessary, But physicians and healthcare systems say it needlessly delays care, increases costs and administrative burden for providers—and takes doctors away from patients to deal with the paperwork and phone calls involved to get insurance carriers authorize care.

Scott said the current system lacks common sense and is hurting both patients and physicians.

"I sit down with a patient, I take a history, I do a physical examination, we talk together about a treatment plan, we come to a decision, and whether that's to order a imaging study or to do a surgical procedure or to even give them a prescription, we leave with the anticipation that that's going to happen. And yet sometimes the insurance company says no. They step in, having never examined the patient, and a lot of times not having gone to medical school. And yet they're the ones who are making the decision from my patient and it harms the patients," Scott explained.

He said AMA physician survey data shows that over 90% say that delays and denials, mostly due prior authorizations, have resulted in harm to patients and contributed to physician burnout. 

"You've got someone who hasn't been to medical school who's questioning your judgment, who's making you go through hoops to get the medication approved. And then the other problem we see with it is that January 1st comes and they want you to reauthorize and start all over again, even though the patient has been successfully on a medication and the course of the medication continues, you have to go through the same hoops all again," Scott said.

Insurance companies are using AI to deny requests

One of Scott’s greatest concerns is the use of AI by insurers to accelerate denials, rather than facilitate care. This was the included as a big concern by AMA members and included in a resolution asking the organization to fight this through advocacy efforts at its 2025 House of Delegates meeting.

"We're concerned that some insurance companies appear to be using AI to rapidly deny more and more of the requested care. That's not the type of reform we're looking for," he said.

However, he did speak to one insurance company recently who said they were going to use AI to rapidly approve prior authorization requests that fit the guidelines, in an effort to make things more efficient. He said that is a step in the right direction.

Scott cited AMA data showing that over 80% of physicians report they had patients abandoned treatment altogether after facing delays or denials.

“Imagine a woman gets a mammogram, and they find a lump and the physician says, we need to do a biopsy. And then the patient waits two to three weeks to find out whether they can have the procedure the whole time fearing that they've got breast cancer. That's just unfair the stress that puts on the patient. And so that's the big harm of prior authorization. It costs the system money. It wastes physicians' time. But the big problem is the issues it causes for our patients. A lot of times patients give up. They go to the pharmacy, the medication's not covered, they leave," Scott explained.

When patients cannot get their blood pressure or diabetes controlled—or the migraine headache treated due to insurance denials—these patients end up in the emergency room, which costs the healthcare system much more that prevention would have.

Solutions to address prior authorization burdens

Scott said the AMA is pushing for four major reforms regarding prior authorizations that include:

  • Transparency – Insurers should clearly communicate what is required for approval and explain denials so physicians can respond appropriately.

 • Speed – Authorization decisions should be expedited, especially when delays could compromise health.

 • Reduction – The volume of procedures and medications requiring authorization should be decreased, particularly when evidence supports their use.

 • Technology Integration – Prior authorization systems should integrate seamlessly with electronic health records (EHRs), eliminating outdated fax-based workflows.

“I still fax documents to insurers,” Scott said. “That’s absurd in 2025. We need systems that talk to each other.”

Medicare Advantage and access erosion

With Medicare Advantage enrollment now surpassing 50% of all Medicare beneficiaries, Scott warned that the growing use of prior authorization requirements is disproportionately impacting older Americans—those most in need of timely access to care.

Physicians, particularly in rural areas, are increasingly opting out of accepting Medicare patients or are closing their practices altogether. Scott cited the example of a rural OB-GYN who, facing unsustainable operating costs, burdensome prior authorization processes, and declining reimbursement rates, stopped drawing a salary before ultimately shutting down her practice.

“Medicare payments to physicians have dropped 33% since 2000 when adjusted for inflation,” Scott said. “Meanwhile, rent, staff wages, and supply costs have all gone up.”

He emphasized that while hospitals, surgery centers, and long-term care facilities receive inflation-based payment increases through Medicare, physicians do not. Scott noted that physicians aren't seeking windfall profits—they're simply asking for enough to keep the lights on and their doors open.

Access threat to the healthcare system

Scott warned that without action on prior authorization reform, access to care in some communities could collapse entirely.

"One of the things that's frustrating that I hear from legislators, they say, 'oh, the number of participating physicians in Medicare hasn't gone down,' but just try to find a doctor for your mother or your father who's on Medicare right now. Even patients I'm hearing have to plan their annual visit 18 months in advance. How does that even make sense? So that's the access issue that exists right now. And when you reduce what you're able to pay doctors and private practice doctors like me say we can't make it work anymore," Scott explained.

The U.S. is facing a growing shortage of physicians, particularly in rural areas where it is increasingly difficult to find specialists such as OB/GYNs, radiologists, and cardiologists. Many are drawn to higher-paying positions and improved quality of life in urban settings. Today, fewer than 50% of U.S. counties have access to obstetric or cardiology services, forcing patients in many regions to travel several hours for care. This situation is expected to worsen in the coming years due to declining reimbursement rates and ongoing insurance-related barriers that continue to limit patient access to essential care.

"These are our senior citizens, the ones who've been promised Medicare, and yet there is no Medicare if there are no physicians," Scott explained/

Scott said the AMA will continue its advocacy at both the state and federal levels, but emphasized that meaningful reform will require unified action from the medical community, lawmakers, and the public.