Prior authorization is required for over 70% of imaging services for cancer care, according to survey findings published October 18 in JAMA Network Open.
A team led by Fumiko Chino, MD, from the Memorial Sloan Kettering Cancer Center in New York, also found that prior authorization led to 22% of patients not receiving the care recommended by their treatment team and that most respondents experienced a delay in recommended oncology care.
“This study suggests that prior authorization for cancer care can have discrete negative associations with outcomes for patients,” Chino and colleagues wrote.
Prior authorization is a process used by some health insurance companies to determine if they will cover a prescribed procedure, service, or medication. This means clinicians and patients must negotiate through a complex approval pathway, which can lead to delays and denials.
Some insurance companies, such as UnitedHealthcare, have plans in place to eliminate prior authorization requirements, including those for many radiology services.
Chino and co-authors sought to study the patient perspective of prior authorization for cancer-related care. This included perceptions about the process, outcomes, and patient administrative burden.
The researchers gathered survey data from 178 respondents, 158 of whom were women and 151 of whom were non-Hispanic white. They found that 112 (63%) respondents reported that their cancer care was approved and given as recommended, while 39 (22%) did not receive recommended care due to delays or denials. However, 123 of the total respondents (69%) reported a prior authorization-related delay in care. Of these, 90 (73%) reported a delay of two or more weeks.
The team also reported that prior authorization was most frequently required for imaging at 126 cases (71%). It was also needed for intravenous chemotherapy (49%), surgery (47%), and radiotherapy (34%).
The researchers also found that 119 respondents (67%) had to become personally involved in the prior authorization process. Of these, 35 (20%) spent 11 or more hours dealing with prior authorization issues.
Additionally, 125 of the respondents rated the prior authorization experience as “bad” or “horrible.” The ratings were significantly associated with the length of delay (ρ = 0.36, p < 0.001) and the time spent on prior authorization (ρ = 0.42, p < 0.001).
The study authors highlighted that focusing on patient experiences in this area brings up a “missing perspective” in policy discussions. They added that their results suggest that prior authorization is a potential factor tied to eroding trust in the healthcare system.
“Streamlining the prior authorization process is key to optimizing the quality of care delivered and improving patients’ experience with cancer care,” the authors wrote. “Policy interventions will be necessary to reform the prior authorization process, as will advocacy efforts at the patient, clinician, and hospital level.”
The full study can be found here.
