School of Medicine, University of Utah, Salt Lake City.
Department of Dermatology, Broward Health, Fort Lauderdale, Florida.
JAMA Dermatol. 2020 Oct 1;156(10):1074-1078. doi: 10.1001/jamadermatol.2020.1852.
Insurance companies use prior authorizations (PAs) to address inappropriate prescribing or unnecessary variations in care, most often for expensive medications. Prior authorizations negatively affect patient care and add costs and administrative burden to dermatology offices.
To quantify the administrative burden and costs of dermatology PAs.
DESIGN, SETTING, AND PARTICIPANTS: The University of Utah Department of Dermatology employs 2 full-time and 8 part-time PA staff. In this cross-sectional study at a large academic department spanning 11 clinical locations, these staff itemized all PA-related encounters over a 30-day period in September 2016. Staff salary and benefits were publicly available. Data were analyzed between December 2018 and August 2019.
Proportion of visits requiring PAs, median administrative time to finalize a PA (either approval or denial after appeal), and median cost per PA type.
In September 2016, 626 PAs were generated from 9512 patient encounters. Staff spent 169.7 hours directly handling PAs, costing a median of $6.72 per PA. Biologic PAs cost a median of $15.80 each and took as long as 31 business days to complete. The costliest PA equaled 106% of the associated visit's Medicare reimbursement rate. Approval rates were 99.6% for procedures, 78.9% for biologics, and 58.2% for other medications. After appeal, 5 of 23 (21.7%) previously denied PAs were subsequently approved.
Prior authorizations are costly to dermatology practices and their value appears limited for some requests. Fewer unnecessary PAs and appeals might increase practice efficiency and improve patient outcomes.
保险公司使用预先授权 (PA) 来解决不当处方或护理中不必要的差异，通常是针对昂贵的药物。预先授权会对患者护理产生负面影响，并给皮肤科诊所增加成本和行政负担。
量化皮肤科 PA 的行政负担和成本。
设计、设置和参与者：犹他大学皮肤科雇有 2 名全职和 8 名兼职 PA 工作人员。在这项大型学术部门的横断面研究中，跨越 11 个临床地点，这些工作人员在 2016 年 9 月的 30 天内详细列出了所有与 PA 相关的就诊情况。工作人员的薪资和福利是公开的。数据在 2018 年 12 月至 2019 年 8 月之间进行分析。
需要 PA 的就诊比例、完成 PA 的中位数行政时间（包括上诉后的批准或拒绝）以及每种 PA 类型的中位数成本。
2016 年 9 月，从 9512 次患者就诊中生成了 626 个 PA。工作人员直接处理 PA 花费了 169.7 个小时，每个 PA 的中位数成本为 6.72 美元。生物制剂 PA 的中位数费用为每个 15.80 美元，完成时间最长可达 31 个工作日。最昂贵的 PA 等于相关就诊 Medicare 报销率的 106%。程序的批准率为 99.6%，生物制剂为 78.9%，其他药物为 58.2%。上诉后，23 个先前拒绝的 PA 中有 5 个（21.7%）随后获得批准。
预先授权对皮肤科实践来说成本高昂，而且对于某些请求来说其价值似乎有限。减少不必要的 PA 和上诉可能会提高实践效率并改善患者的结果。
