Albany Medical College, Albany, NY.
Brown university, Providence, RI.
Urology. 2022 Nov;169:76-83. doi: 10.1016/j.urology.2022.05.055. Epub 2022 Aug 9.
To determine the final outcomes of various types of prior authorizations (PAs), and to quantify the administrative and financial burden of PAs on urology practice. PAs are often required before imaging, procedures or medications can be ordered. However, they can delay timely delivery of patient care and place a significant administrative burden on practices. The impact of PAs has been poorly studied, and no studies on PAs burden on urology practice are available.
Imaging and medications requiring PAs from an outpatient urology clinic from November 2020 to February 2021 were reviewed (n = 267). Authorization outcomes were tracked to resolution. We calculated the time spent on PAs, and the estimated overall financial burden on the practice.
Of the PAs required, 60.6% were for imaging and 39.4% were for medications. Initial decision for PAs took a median of 2 days [IQR: 0-6, Range: 0-36], whereas decisions after an appeal (n = 51) took a median of 10 days [IQR: 5-23, range 0-125 days]. Private insurance compared to Medicare or Medicaid, has an earlier time to decision (P =<.001). Initial approval rates were 67.5%, and final approval rates after appeals were 88.2%. Of orders originally denied, a majority (77.3%) were appealed, 13.6% required alternative orders, and 7.6% paid out of pocket. The total cost to the practice was $2206.06, with a $15.11 mean cost of each PA.
PAs for imaging studies and medications pose a significant administrative and financial burden to urology patients and practice.
确定各种类型的预授权（PA）的最终结果，并量化 PA 对泌尿科实践的管理和经济负担。在开具影像、程序或药物之前，通常需要进行 PA。然而，它们可能会延迟及时提供患者护理，并给实践带来重大的管理负担。PA 的影响研究甚少，目前尚无关于 PA 对泌尿科实践负担的研究。
审查了 2020 年 11 月至 2021 年 2 月期间门诊泌尿科诊所需要的影像和药物的 PA（n=267）。跟踪授权结果直至解决。我们计算了 PA 所花费的时间以及对实践的总体财务负担的估计。
所需的 PA 中，60.6%用于影像，39.4%用于药物。PA 的初始决策中位数为 2 天[IQR：0-6，范围：0-36]，而上诉后（n=51）的决策中位数为 10 天[IQR：5-23，范围 0-125]。与医疗保险或医疗补助相比，私人保险的决策时间更早（P<.001）。初始批准率为 67.5%，上诉后的最终批准率为 88.2%。最初被拒绝的订单中，大多数（77.3%）被上诉，13.6%需要替代订单，7.6%自掏腰包支付。该实践的总成本为 2206.06 美元，每个 PA 的平均费用为 15.11 美元。
影像研究和药物的 PA 给泌尿科患者和实践带来了重大的管理和经济负担。
