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ASTRO: Prior Authorization Process Costly to Radiation Oncology Clinics

Time, cost burdens of treatment-related prior authorizations high for academic radiation oncology practices in the United States

MONDAY, Nov. 1, 2021 (HealthDay News) — The time and cost burden of treatment-related prior authorization (PA) events for radiation oncology practices is considerable, according to a study presented at the annual meeting of the American Society for Radiation Oncology, held from Oct. 24 to 27 in Chicago.

Brian S. Bingham, M.D., from the Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues performed internal analyses to generate time-driven activity-based costing process maps for treatment-related PA events at an academic medical center. Based on event frequency and average personnel requirements, the cost of each PA event was calculated, and annual departmental costs were then estimated.

The researchers found significant time and cost burdens for all events (range, 51 to 95 minutes; $28 to $101); when peer-to-peer discussions were required, there were significant increases (range, 92 to 95 minutes; $75 to $101). Financial clearance specialist requirements were relatively fixed per episode (range, 48 to 54 minutes; $21 to $23). Attending physician requirements were variable (range, 2 to 28 minutes; $6 to $71). Annual treatment-related PA departmental costs were estimated at $491,989; the vast majority of treatments (94 percent) were subsequently approved. For all academic practices nationally, annual treatment-related PA costs were estimated at $40,125,848, of which 86 percent was for subsequently approved treatments.

“We expected that prior authorization was expensive, but the degree of expense was eye-opening, especially given how often we go through this time-intensive process without significant changes to what we’ve prescribed,” Bingham said in a statement.

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