Bukstein Don A, Cherayil Greeta A, Gepner Adam D, Luskin Allan T, Kooistra J Brent, Olson Reid M
Department of Allergy, Dean Medical Center, Madison, Wisconsin 53715, USA.
Allergy Asthma Proc. 2006 Mar-Apr;27(2):119-22.
Costs for managed care organizations to process prior authorizations (PAs) for nonformulary medications have been estimated to be dollars 20-25 per request. Costs for physicians to process these requests have not been studied extensively. A data collection tool was developed and used by physicians and nurses to document time spent on processing PAs. Data were collected over 8 weeks and 117 requests were processed. Nurses averaged 5.6 +/- 6.5 calls per day per nurse and spent an average of 17 minutes per call. Physicians averaged 1.9 +/- 1.2 calls per day averaging 5.8 +/- 5.0 minutes per call. During the study period nurses spent >40 hours on 231 calls and physicians spent >8 hours on 154 calls. Based on the hourly rate of the nurses and physicians, the total cost in this specialty practice was dollars 17.77 per PA. Of the 117 PA requests, 98.7% were approved the first time they were processed. There are substantial costs with processing PAs for nonformulary drugs on the physician office side of managed care as well as on the insurance side of the process. Specialty physicians should have a different process for obtaining notformulary medications because almost 100% of their requests are granted.
据估计，管理式医疗组织处理非处方药物预先授权（PA）的成本为每份申请20至25美元。医生处理这些申请的成本尚未得到广泛研究。开发了一种数据收集工具，供医生和护士用来记录处理预先授权所花费的时间。在8周内收集了数据，共处理了117份申请。护士平均每人每天拨打5.6±6.5个电话，每次通话平均花费17分钟。医生平均每人每天拨打1.9±1.2个电话，每次通话平均花费5.8±5.0分钟。在研究期间，护士在231次通话上花费了超过40小时，医生在154次通话上花费了超过8小时。根据护士和医生的小时费率，该专科诊所处理每份预先授权的总成本为17.77美元。在117份预先授权申请中，98.7%在首次处理时获得批准。在管理式医疗的医生办公室方面以及保险流程方面，处理非处方药物的预先授权都存在大量成本。专科医生在获取非处方药物时应有不同的流程，因为他们几乎100%的申请都会获批。
