Prior authorizations are hurting cancer patient outcomes, the American Society for Radiation Oncology said in a new report citing a poll finding 93% of radiation oncologists said PA delays prevented their patients from receiving life-saving treatment. One-third of these doctors reported resorting to different therapy for over 10% of patients because of the delays.
Roughly two-thirds of respondents reported most PA denials were overturned on appeal, with 41% of radiation oncologists estimating the rate of overturn reaches as high as 76-100% of denials.
Nearly 20% of providers surveyed said more than 10% of their workday is spent on PAs and almost two-thirds hired additional staff to help with the paperwork.
Prior authorization is a frequent target for providers' ire. For clinicians, restrictive PA practices delay or halt needed care, add physician burden and negatively impact patients' relationships with providers. Radiation oncologists in the survey said patients are noticing the delays, with 73% of clinicians reporting patients "regularly" express concern about the holdups.
The oncologists said the delays are causing harm and pointed to research warning delays in treatments for new cancer patients adversely affects outcomes, with each week of delay in starting therapy adding a 1.2% to 3.2% higher risk of mortality.
The problem is sharper in private insurance than public, with the online survey of 620 ASTRO member physicians finding PAs are much more common with commercial insurance (96%) than Medicare (20%). Over half of radiation oncologists reported treatment decisions in Medicare Advantage plans triggered PA review.
Earlier this year, the American Medical Association (AMA) said nearly all providers surveyed believe PAs are undermining patient outcomes and that the problem is getting worse.
The American Academy of Family Physicians called the practice family physicians' "number one administrative burden."
The AMA and American Hospital Association are currently working with payer groups like America’s Health Insurance Plans and Blue Cross Blue Shield Association in hopes of improving the PA process.
A consensus statement says the groups are looking to cut the number of healthcare professionals needed for PA requirements, regularly review requirements and improve communication between stakeholders to “minimize care delays and ensure clarity.” They also hope to accelerate the adoption of national electronic standards for PAs.