Prior authorization leads to ‘crippling delays and dysfunction’ in health care system

Ninety-three percent of radiation oncologists experienced delays in delivering treatments because of prior authorization requirements from insurance providers, according to results of a survey conducted by the American Society for Radiation Oncology.

Nearly one-third of those surveyed (32%) reported average delays of 4 to 5 days when seeking prior authorization, with 31% citing average delays of 5 days or more.

“Prior authorization requirements introduce crippling delays and dysfunction into our health care system,” Bruce A. Scott, MD, vice speaker of the AMA’s House of Delegates, said during a press briefing announcing the survey results.

Scott emphasized that the prior authorization process continues to interfere with shared decision-making between physicians and patients and that the process needs to be overhauled.

“It adds stress for our patients, and it’s simply bad medicine,” he said. “Delays can potentially change the treatment plan and sometimes the outcome.”

The results include data from 673 radiation oncologists who responded to ASTRO’s 2018 annual member survey. It included responses from radiation oncologists in both private practice/community-based systems (56%) and those within academic systems (43%).

Paul Harari, MD, chair of ASTRO’s board of directors, said that prior authorization has become an increasingly major issue among his organization’s members over the past several years and that delays in prior authorization are “a constant source of concern” at his practice at University of Wisconsin.

Paul Harari, MD
Paul Harari

Harari revealed that ASTRO’s 2018 member survey showed prior authorization requirements were a primary obstacle to the delivery of care and the No. 1 challenge facing the field of radiation oncology.

“Prior authorization wastes time that physicians could be devoting to taking care of their patients,” he said.

Nearly two-thirds (62%) of survey respondents said most of the denials they received from insurers were overturned on appeal. Nearly half (44%) of respondents said their peer-to-peer reviews with the insurance provider were not conducted by a radiation oncologist.

“This raises serious questions about the justification of the denial in the first place,” said Vivek Kavadi, MD, vice chair of ASTRO’s payer relations subcommittee.

Kavadi highlighted the consequences of prior authorization delays via a report from researchers at Cleveland Clinic, who found an increased risk for mortality ranging from 1.2% to 3.2% for each week of delay before starting cancer treatment.

The survey results showed that 44% of radiation oncologist needed prior authorization for at least half of their treatment recommendations and 63% needed to hire additional staff to address the need for prior authorizations.

The original purpose of prior authorization was to ensure patients received the most effective and appropriate treatment available and in the most efficient manner, Kavadi said. However, given his own experience and the survey results, he questioned whether the policy was achieving its goals.

Kavadi asked: “In an era of value-based care, where is the value if we are adding cost but not receiving any clinical benefit?” – by Drew Amorosi

References:

ASTRO. Prior authorization survey results. Available at: www.astro.org/ASTRO/media/ASTRO/News%20and%20Publications/PDFs/ASTROPriorAuthorizationPhysician-SurveyBrief.pdf. Accessed on April 25, 2019.

Khorana AA, et al. PLoS One. 2019;doi:10.1371/journal.pone.0213209.

Disclosures: HemOnc Today could not confirm the speakers’ relevant financial disclosures at the time of reporting.

Ninety-three percent of radiation oncologists experienced delays in delivering treatments because of prior authorization requirements from insurance providers, according to results of a survey conducted by the American Society for Radiation Oncology.

Nearly one-third of those surveyed (32%) reported average delays of 4 to 5 days when seeking prior authorization, with 31% citing average delays of 5 days or more.

“Prior authorization requirements introduce crippling delays and dysfunction into our health care system,” Bruce A. Scott, MD, vice speaker of the AMA’s House of Delegates, said during a press briefing announcing the survey results.

Scott emphasized that the prior authorization process continues to interfere with shared decision-making between physicians and patients and that the process needs to be overhauled.

“It adds stress for our patients, and it’s simply bad medicine,” he said. “Delays can potentially change the treatment plan and sometimes the outcome.”

The results include data from 673 radiation oncologists who responded to ASTRO’s 2018 annual member survey. It included responses from radiation oncologists in both private practice/community-based systems (56%) and those within academic systems (43%).

Paul Harari, MD, chair of ASTRO’s board of directors, said that prior authorization has become an increasingly major issue among his organization’s members over the past several years and that delays in prior authorization are “a constant source of concern” at his practice at University of Wisconsin.

Paul Harari, MD
Paul Harari

Harari revealed that ASTRO’s 2018 member survey showed prior authorization requirements were a primary obstacle to the delivery of care and the No. 1 challenge facing the field of radiation oncology.

“Prior authorization wastes time that physicians could be devoting to taking care of their patients,” he said.

Nearly two-thirds (62%) of survey respondents said most of the denials they received from insurers were overturned on appeal. Nearly half (44%) of respondents said their peer-to-peer reviews with the insurance provider were not conducted by a radiation oncologist.

“This raises serious questions about the justification of the denial in the first place,” said Vivek Kavadi, MD, vice chair of ASTRO’s payer relations subcommittee.

Kavadi highlighted the consequences of prior authorization delays via a report from researchers at Cleveland Clinic, who found an increased risk for mortality ranging from 1.2% to 3.2% for each week of delay before starting cancer treatment.

The survey results showed that 44% of radiation oncologist needed prior authorization for at least half of their treatment recommendations and 63% needed to hire additional staff to address the need for prior authorizations.

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The original purpose of prior authorization was to ensure patients received the most effective and appropriate treatment available and in the most efficient manner, Kavadi said. However, given his own experience and the survey results, he questioned whether the policy was achieving its goals.

Kavadi asked: “In an era of value-based care, where is the value if we are adding cost but not receiving any clinical benefit?” – by Drew Amorosi

References:

ASTRO. Prior authorization survey results. Available at: www.astro.org/ASTRO/media/ASTRO/News%20and%20Publications/PDFs/ASTROPriorAuthorizationPhysician-SurveyBrief.pdf. Accessed on April 25, 2019.

Khorana AA, et al. PLoS One. 2019;doi:10.1371/journal.pone.0213209.

Disclosures: HemOnc Today could not confirm the speakers’ relevant financial disclosures at the time of reporting.