The reality of peer-to-peer reviews: Delays, admin burden, strained patient care

For many healthcare providers, obtaining authorization for advanced imaging studies, infusion therapies, and other high-cost services has become increasingly dependent on a process known as a peer-to-peer (P2P) review.  

In theory, P2P discussions allow a health-plan physician to review a clinical scenario with the treating clinician to ensure that care is medically necessary. 

Health plans generally view peer-to-peer reviews as a safeguard against unnecessary utilization, care variation, and rising healthcare costs. In certain circumstances, these discussions can help clarify documentation, address unusual clinical scenarios, or ensure adherence to evidence-based treatment pathways. The challenge arises when P2P reviews are routinely required for services that already meet well-established clinical guidelines and coverage criteria, creating administrative work that delivers little additional clinical value. 

In practice, these reviews frequently create significant administrative burden, treatment delays, provider frustration, and unnecessary costs for both patients and health systems. 

Advanced imaging for cancer staging, MRI studies for patients who meet evidence-based criteria, and infusion therapies for chronic inflammatory diseases often require additional review despite extensive documentation submitted during the prior authorization process. As a result, providers are forced to dedicate valuable clinical time to defending treatment decisions that have already been carefully considered, documented, and often are considered the standard of care.

The administrative burden of peer-to-peer reviews 

One of the most significant pain points of these reviews is the administrative burden placed on healthcare organizations. Scheduling a P2P review frequently involves multiple phone calls, limited availability windows, and repeated follow-up by utilization management staff.  

Physicians, advanced practice providers, nurses, and authorization specialists spend countless hours coordinating and participating in P2P discussions rather than focusing on patient care. Large health systems may conduct hundreds or even thousands of reviews annually, creating substantial labor costs and extensive resource utilization.  

The broader prior authorization process already consumes significant provider resources. According to the AMA’s 2025 Prior Authorization Physician Survey, physicians complete an average of 40 prior authorization requests each week, and prior authorization activities consume approximately 13 hours of physician and staff time weekly. Additionally, two in five physicians (40%) employ staff dedicated exclusively to managing authorization requirements. While P2P reviews represent only one component of the authorization process, they often add another layer of coordination and clinical time to an already resource-intensive workflow.

How peer-to-peer reviews delay patient care 

Peer-to-peer requirements also contribute to delays in diagnosis and treatment.  

These delays are not merely administrative inconveniences. According to the AMA’s 2025 survey, 95% of physicians reported that prior authorization requirements delay access to necessary care, while 92% reported negative impacts on clinical outcomes. Nearly four in five physicians (79%) reported that patients sometimes abandon recommended treatment due to authorization-related barriers, often because they are awaiting MRI, CT, PET, or other advanced imaging studies.  

For oncology patients, delayed imaging can postpone treatment and increase anxiety during an already stressful period.  

Consider a patient newly diagnosed with lung cancer who requires a PET scan for staging. Even when clinical documentation aligns with established guidelines and payer policies, the request may still be routed for P2P review. 

Similarly, patients receiving infusion therapies for conditions such as rheumatoid arthritis, psoriatic arthritis, Crohn’s disease, or multiple sclerosis may experience interruptions in therapy that delay care. This can result in disease progression, symptom flare-ups, and costly, avoidable emergency department visits or hospitalizations.  

While a single delay may appear minor, these situations occur repeatedly across health systems every day. 

Why providers question the peer-to-peer process 

Beyond delays, peer-to-peer reviews can lead to inconsistent documentation and approval outcomes. Providers may encounter different interpretations of medical necessity criteria depending on the reviewing physician, health plan, or vendor conducting the review. Even when clinical documentation clearly supports the requested service, approval outcomes can vary.  

The AMA’s 2025 survey reinforces this concern. Of the physicians questioned, only 16% felt that the health plan’s “peer” had the appropriate qualifications or had practiced medicine in a similar specialty.

Many providers do not object to clinical review itself; rather, they question whether the process truly functions as a peer discussion when reviewers may practice in a different specialty or lack experience treating similar patient populations. A meaningful conversation between clinicians with comparable expertise can provide value. However, when specialty alignment is lacking, providers often perceive the process as administrative rather than clinical.  

These inconsistencies create uncertainty for providers and patients alike while undermining confidence in the authorization process. 

The impact on physician burnout 

The impact of P2P reviews extends beyond workflow inefficiencies. According to the AMA’s 2025 survey, 94% of physicians reported that prior authorization contributes to physician burnout, with P2P reviews frequently adding another layer of administrative burden.   

Physicians are already navigating increased documentation requirements, staffing shortages, and growing patient volumes; adding mandatory discussions with insurance reviewers (often during clinic hours) forces providers to choose between patient care responsibilities and administrative tasks. Frustrations are only amplified when reviews appear to focus on checking administrative boxes rather than engaging in mutual, meaningful clinical dialogue.

Ultimately, patients bear the consequences of these inefficiencies. Delayed care, rescheduled appointments, uncertainty regarding treatment plans, and unexpected financial burdens can all negatively affect the patient experience and clinical outcomes.  

For individuals managing chronic conditions, even short delays can have significant clinical consequences. Patients often struggle to understand why a recommended service requires additional review after their physician has already determined it is medically appropriate. 

Reducing unnecessary peer-to-peer reviews at the point of care 

One of the most effective ways to reduce P2P volume is to address medical-necessity challenges at the point of care, when an order is submitted, before downstream revenue cycle teams become involved. When clinicians have access to an intelligent medical necessity solution embedded directly into their workflow, they can receive real-time guidance on payer requirements, coverage criteria, and documentation gaps while the patient is still in front of them.  

Proactive intervention reduces the number of “hands in the pot” by minimizing the need for back-end review by prior-authorization teams, utilization-management staff, schedulers, and denial specialists. It also helps align providers and payers more effectively by ensuring that ordered services more closely match current coverage policies and evidence-based guidelines from the outset. 

Importantly, providers are often willing to accept a few additional clicks within their workflow if those clicks lead to fewer interruptions later and more meaningful time with patients. The key is ensuring these solutions are seamlessly integrated and intelligently designed to support, not hinder, clinical decision-making.  

Equally critical is using a platform that is continuously updated and maintained by clinical terminology and policy experts. Because payer policies change constantly, manual policy review quickly becomes unsustainable for healthcare organizations.  

A dynamic, expertly maintained solution eliminates much of this burden by translating complex payer requirements into actionable guidance at the moment decisions are made, reducing avoidable denials, unnecessary reviews, and administrative waste across the care continuum. 

What clinicians can do today 

Broader payer and regulatory reforms may take time to materialize. In the meantime, provider organizations can begin reducing peer-to-peer volume by identifying high-denial service lines, analyzing common denial patterns, improving documentation workflows, and standardizing order-entry processes. Organizations that surface payer requirements earlier in the care journey are often better positioned to avoid downstream authorization challenges and reduce unnecessary administrative work. 

When peer-to-peer reviews add value – and when they don’t 

Peer-to-peer reviews are most valuable when clinical circumstances are complex, documentation is incomplete, or treatment plans fall outside established guidelines. When routinely applied to common, guideline-supported services, however, these reviews often generate administrative work, delays, and frustration without delivering proportional clinical value.

Opportunities for improvement may include greater transparency into denial rationales, standardized medical-necessity criteria, and expanded use of clinical decision-support tools.  

Ultimately, reducing unnecessary peer-to-peer requirements should be a priority for insurers, improving access to care, reducing administrative costs, and allowing clinicians to focus on what matters most: caring for patients.   

Learn more about our revenue cycle management solution, or schedule a demo to see how it could meet your unique needs.