annually in employee time to obtain prior authorization for radiation therapy treatments. Extrapolated nationally, the researchers estimated that physicians' annual compensation for prior authorization duties came to an estimated $46 million. Overall, 86% of these costs were for treatments that were ultimately approved, the majority on initial request and some on appeal.
Data from the Texas Oncology network indicate that for every five doctors, there is one full-time employee dedicated to prior authorization, Kavadi explained. Across a region of 60 doctors, that comes to a dozen full-time prior authorization employees, which costs the network about $960,000 per year.
And after a week of delays and hours on the phone with the insurer, his patient's radiation treatment was ultimately approved.Stretching out an approval for a standard radiation treatment"feels like a means of intentionally delaying care," Kavadi said."This is an example of a process that has run so far amok. It's just a burden across the board."
And even with his 30 years of experience,"I still have to ask my business supervisor what I am allowed to do," he said."I can't just proceed with what's best for my patient, what the patient has consented to, and what also happens to be the least expensive option."series on issues oncologists and people with cancer face navigating health insurance company requirements.
Please email vstern@medscape.net to share experiences with prior authorization or other challenges receiving care.