Prior-Authorization Requirement Exacts Huge Financial Toll on Radiation-Oncology Clinics
NEW YORK (Reuters Health) – In the United States, prior-authorization requirements cost radiation-oncology clinics more than $40 million annually, according to new research.
“Physician and staff time are finite resources and need to be directed towards the most clinically meaningful activities,” said Dr. Brian Bingham of Vanderbilt University Medical Center in Nashville, Tennessee, in a presentation of the findings at the American Society for Radiation Oncology (ASTRO) annual meeting.
Prior authorization imposes a significant time burden on all medical practices, and recent data demonstrates that radiation oncology is first among all medical specialties with the highest prior-authorization burden. But to date, the financial impact of this prior-authorization burden has not been characterized, he explained.
In an internal departmental analysis, the Vanderbilt team found that the average time it takes to complete a prior authorization is between 51 and 95 minutes, at a cost of $28 to $101.
“Our attendings reported an average of 8.3% of their work day dedicated towards prior-authorization-related activities, with treatment approvals accounting for the majority of those (87%), with an overall approval rate of 94%,” Dr. Bingham reported.
“This led to an estimate of annual prior-authorization costs of over $560,000 for our department. From that cost, over 490,000 was spent on treatment-related prior-authorization requests, with over 460,000 being spent on treatments that were approved,” he said.
Using ASTRO data, the team generated a national estimate of the burden of prior authorization based on 1,434 radiation oncologists practicing in academic or university settings, each spending about 46 minutes per day on prior authorization-related activities.
“This led to an annual estimate of over $46 million dollars being spent by academic radiation-oncology departments, compensating physicians for the time spent on prior authorization. Treatment-related approvals accounted for the majority of that, at just over $40 million,” Dr. Bingham reported.
“This serves to show that prior-authorization burdens are significant and they translate into massive organizational costs annually,” he added.
This work is “really important,” said ASTRO invited discussant Dr. Karen Winkfield, breast radiation oncologist with Vanderbilt University Medical Center.
“Some people think that radiation oncologists are just technicians. They don’t think about how much time and effort goes into creating a thoughtful plan for our patients – and more importantly, the time that it takes for us to call on the phone over and over again, for simple things,” Dr. Winkfield said.
“Our goal is to make sure that every person survives cancer and survives it well. When I have to call for prior approval, because I said I was going to have 21 fractions, and the insurance company says they’re only going to approve 20, it causes radiation oncologists to say, I don’t want to do this anymore. And we’re already a small subspecialty,” she noted.
At the institutional level, Dr. Bingham encouraged radiation-oncology practices examine their prior-authorization practices to look for potential inefficiencies and come up with streamlined workflows.
On a national level, he encouraged support of H.R.3173, the Improving Seniors’ Timely Access to Care Act of 2021, which was introduced recently in the U.S. Senate and in May in the House.
SOURCE: https://bit.ly/2ZvRpxR American Society for Radiation Oncology (ASTRO) Annual Meeting, presented October 25, 2021.
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