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Prior authorization in gynecologic oncology: An analysis of clinical impact.
Smith, Anna Jo Bodurtha; Mulugeta-Gordon, Lakeisha; Pena, Daniella; Kanter, Genevieve P; Bekelman, Justin E; Haggerty, Ashley E; Ko, Emily M.
Afiliación
  • Smith AJB; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; University
  • Mulugeta-Gordon L; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America.
  • Pena D; Cornell University, Ithaca, NY, United States of America.
  • Kanter GP; Department of Medicine, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Department of Medical Ethics and Health Policy, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; University of Pennsylvania, Leonard Davis Institute of
  • Bekelman JE; Department of Radiation Oncology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; University of Pennsylvania, Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Penn Center for Can
  • Haggerty AE; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America.
  • Ko EM; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; University
Gynecol Oncol ; 167(3): 519-522, 2022 Dec.
Article en En | MEDLINE | ID: mdl-36244827
BACKGROUND: Prior authorization was designed to minimize unnecessary care and reduce spending but has been associated with delays in necessary care. Our objective was to estimate the occurrence of prior authorization, and impact on cancer care, in gynecologic oncology. METHODS: We performed a retrospective cross-sectional study of patients seen in University of Pennsylvania gynecologic oncology practices (January-March 2021). Using electronic medical records, we measured the incidence of prior authorization during the 3-month period and prior experience of prior authorization for cancer care overall and by type of order (chemotherapy, imaging, surgery, prescription drugs). We assessed the impact of prior authorization occurrence on clinical outcomes (time to service, changes in care). RESULTS: Of the 2112 clinic visits of 1406 unique patients, 5% experienced prior authorization during the 3-month study period. An additional 20% faced prior authorization requests earlier in cancer care. Of the 83 prior authorization requests, imaging accounted for the majority (54%) followed by supportive medications (29%) and chemotherapy (17%). After appeal, 79% of cases were approved. For patients whose prior authorizations were approved, there was a mean of 16 days from order placement to care delivery (95% CI 11-20, range 0-98 days). Of the 17 denials, 3 (18%) led to a substantial change in care (i.e., not receiving planned treatment). CONCLUSION: 25% of gynecologic oncology patients experienced prior authorization during their cancer care. While 80% of claims were ultimately approved, patients experienced over a 2-week delay in care when prior authorization occurred. Reform is needed to reduce the burden of prior authorization in oncology.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención a la Salud Tipo de estudio: Observational_studies / Risk_factors_studies Aspecto: Equity_inequality Límite: Female / Humans País/Región como asunto: America do norte Idioma: En Revista: Gynecol Oncol Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención a la Salud Tipo de estudio: Observational_studies / Risk_factors_studies Aspecto: Equity_inequality Límite: Female / Humans País/Región como asunto: America do norte Idioma: En Revista: Gynecol Oncol Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos