Prior authorization for imaging causing anxiety, administrative burden for cancer patients
Prior authorization for imaging and other services is increasing anxiety and administrative burdens for cancer care patients, according to new survey data published in JAMA Network Open [1].
Memorial Sloan Kettering recently conducted the single-center anonymous survey, aiming to gauge how these health insurer-imposed impediments may impact the patient experience. Investigators utilized social media and email lists from cancer advocacy organizations, reaching a total of 178 individuals over a three-month period last year.
Of those, 69% (123) reported a prior authorization-related delay in care, with 73% of that sample (90) experiencing setbacks lasting two weeks or longer. Prior authorization was most frequently required for imaging (71% or 126 patients), followed by IV chemotherapy (49%/87), surgery (47%/84) and radiotherapy (34%/60). Alarmingly, about 22% of patients did not receive the care recommended by their treatment team because of prior authorization, researchers reported.
“Focusing on patient experiences with PA highlights a missing perspective in policy discussions and suggests another potential factor associated with eroding trust in the healthcare system,” Fumiko Chino, MD, with the Department of Radiation Oncology at New York-based MSK, and colleagues concluded. “Streamlining the PA process is key to optimizing the quality of care delivered and improving patients’ experience with cancer care. Policy interventions will be necessary to reform the PA process, as will advocacy efforts at the patient, clinician, and hospital level.”
The findings highlight the heavy volume of red tape already-stressed cancer patients must navigate in this process. About 67% of individuals said they had to become personally involved in the PA process, and 20% spent 11 or more hours with such tasks. Asked to rate their experience with prior authorization, 40% labeled it as “bad” and 32% “horrible.” Ratings appeared to correlate with the length of the care delay and time spent on PA. Self-reported PA-related anxiety was higher than typical scores, the authors noted, and also correlated with delay length, time spent on PA and overall experience.
After navigating this issue, 89% of patients said they trusted their insurance company less and 83% felt the same about the healthcare system.
“To our knowledge, this study is the first to ask oncology patients about their experience with PA,” the authors wrote. “Understanding the patient perspective is a vital component of efforts to refine the PA process, given that patients (and their families) are ultimately financially responsible for resultant medical bills and often must take on the administrative burdens of PA while simultaneously managing the physical and psychosocial effects of their disease and treatment.”
Read more about the results, including potential study limitations, at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.