A survey of spine surgeons’ perceptions about insurance preauthorization delays or denials indicate these conditions negatively impact the scheduling of surgeries and OR use and lead to reduced reimbursement.
“The data is clear that surgeons’ assessments of insurance preauthorization delays and denials have a significant negative impact on patient care, surgical scheduling and the efficient utilization of operating room block time,” Marcus Stone, PhD, an author of the study, said in a press release from the International Society for the Advancement of Spine Surgery. “This is the first in a series of studies necessary to understand the true impact of insurer delays and denials on patients, clinics, hospitals and surgeons.”
The researchers identified 571 spine surgeons from the International Society for the Advancement of Spine Surgery membership database. Of these, 115 surgeons responded to the 14-question survey about their perspectives on the incidence and impact of delay or denial of coverage by third-party payers for pre-authorization and payment.
Results showed the mean annual case volume for the respondents was 300. Stone and colleagues noted the case type varied among the surgeons’ clinics with 35.9% cervical, 57.1% lumbar and 7% other.
Surgeons noted 24.6% of cases were denied during the pre-authorization process, with 58.5% of cases denied no more than 3 days prior to the surgery. However, surgeons perceived that 55.6% of the preauthorization denials were ultimately approved for the originally planned surgery.
Surgeons perceived that OR time was unfilled 19% of the time. The number one reason for unfilled OR time was insurance denial for 84.3% of the surgeons, followed by patient medical issues (11.8%), office/hospital inefficiencies (10.8%) and other (5.9%). Investigators found 51.3% of surgeons reported that if fewer preauthorization denials occurred they would better use their OR time, 10.4% reported they would add more cases to OR and 31.3% would better use their OR time and also add more cases. Responses from surgeons also showed 24% of cases had reduced payments and 9.4% of cases lead to no payment. – by Monica Jaramillo
Nunley P, et al. Paper 444. Presented at: International Society for the Advancement of Spine Surgery Annual Meeting; April 6-8, 2016; Las Vegas.
Disclosure: Stone reports no relevant financial disclosures.