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January 10, 2023

How Prior Authorization Software Can Help Oncologists Connect Cancer Patients to Needed Treatments Faster

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

Recently the Association for Clinical Oncology (ACO) released the results of a 2022 survey on prior authorization and cancer treatments. The findings support what we already know: prior authorizations create an administrative burden for providers and impede critical care for patients diagnosed with cancer. Take a closer look at the challenges uncovered by the survey  and learn how prior authorization software addresses barriers to optimal cancer care. 

Prior Authorizations Demand Full-Time Attention 

In an article about the survey results, OncLive explains, “Settings of the participants were well balanced across community or hospital-based health network (35%), private practice (34%), and academic or university (29%).” More than half of those surveyed reported a primary focus on medical oncology, so they are intimately familiar with prior authorization related to cancer care delivery. 

They’re specialists at diagnosing and treating cancer, yet clinical decisions for patient care still depend on convoluted prior authorization requirements. As a result,  52% of surveyed practices must maintain staff dedicated exclusively to prior authorizations, with 47% of practices spending more than 40 hours per week on authorizations alone. 

Perhaps even more frustrating is the fact that the American Society of Clinical Oncology recommended streamlining  prior authorization policies back in 2017 but little has changed since then. Survey participants cite ongoing hurdles, including: 

  • 91% — Lack of transparency and standardization in the process 
  • 97% — Burdensome documentation to demonstrate medical necessity
  • 97% — Unacceptable delays in responses to prior authorization requests
  • 94% — An obstructive appeals process that further delays care
  • 91% — Lack of clinical expertise among prior authorization reviewers

These challenges are well documented, corroborated by surveys conducted by the American Medical Association (AMA) and others. In fact, the 2021 AMA Prior Authorization Physician Survey reveals that despite the fact that 98% of payers say they use peer-reviewed, evidence-based studies for prior authorization programs, 43% of physicians say clinical validity only applies “Sometimes” and 30% say prior authorization requirements are “Rarely” or “Never” evidence based.“  

Prior Authorization Negatively Impacts Patients

A cancer diagnosis can be overwhelming for patients and their loved ones. The last thing patients need are care delays because of prior authorization policies. Yet care delays are commonplace, adding to patient anxiety.  In addition to the impact on providers, the ACO survey revealed that 42% of providers saw delays of more than 1 business day for prior authorization decisions. In fact, the average time to response time on prior authorizations was 5 days with 34% reporting the need to escalate the request. They also reported: 

  • 96% — Delayed treatments
  • 94% — Delayed diagnostic imaging
  • 93% — Patients forced into second-choice therapy
  • 88% — Increased out-of-pocket costs 
  • 87% — Denial of therapy

These delays and denials have serious consequences for patients. The survey respondents cited: 

  • 80% — Disease progression
  • 76% — Denial of genetic testing which could improve the efficacy of patients’ care plans
  • 74% — Hospitalization or emergency department visit
  • 72% — Denial of supportive care
  • 64% — Treatment abandonment 

Nearly 37% of those surveyed said prior authorization challenges ultimately contributed to patient deaths. As Cancer Legal Care’s Erin Hartung noted in a recent interview, “It is just tragic to me to see somebody’s life be affected negatively because of paperwork.” 

Prior Authorization Software Helps Overcome These Challenges

Congress is poised to address prior authorizations when the Senate moves ahead with the House-passed Improving Senior’s Timely Access to Care Act of 2022. But this pending legislation is, as the OncLive article notes, “an inch of progress” in a much longer journey. Rather than waiting for comprehensive change, providers can leverage prior authorization software to address administrative burdens and accelerate patient care. How? 

  • Reduces manual effort by automating the process from benefits verification through prior authorization submission.
  • Removes dependence on institutional knowledge or time-consuming detective work to determine if prior authorization is required and what the submission criteria entails using a payer rules engine and policy library.
  • Decreases rework by 90% by pre-checking submissions for errors and missing information to ensure your prior authorization requests meet payer criteria. 

It can even provide payers with clinical decision support and auto-adjudication for specific code and plan/group combinations, enabling payers to turn around requests more quickly and ensure consistent decisions. 

And that’s just the tip of the iceberg.  Want to  focus on patients, not paperwork and ensure your  patients get the care they need, faster?  Connect with Myndshft today.