Oncology Prior Authorization
Outsourced Prior Authorization For Oncology Care That Transforms Administrative Efficiency
While oncology prior authorization processes were introduced to better manage and control health care costs, the constantly increasing burden on doctors and administrative staff has become a concerning issue.
Unfortunately, this is leading to increasing delays in all medical fields.
It has also become a significant disruption for cancer patients, as it limits the speed at which oncologists can diagnose and treat these people.
At DataMatrix, we have specialized in creating highly effective business processes to limit delays in this patient administrative burden.
To help you better understand the impacts and how our services benefit oncologists and patients, we’ve created this guide to explain it all in more detail.
How Does The Prior Authorization Process Impact Oncology?
Most patients seeking the services of an oncology clinic or department will require a combination of radiology scans, medication, and even surgery, with many of these requiring a prior authorization (PA) request with an insurance company.
Unfortunately, every insurance company has slightly different forms and online systems, which all require varying information.
This complexity in utilization management makes it extremely difficult for administrative staff, nurses, and doctors to consistently fill out the forms correctly.
As a result, many prior authorizations in oncology medical services end up coming back with requests for more information and correction of errors.
For admin teams and doctors, these requests lead to a lot of time spent researching the requested information and often spending hours on hold waiting to get through to the right person at an insurance company.
Ultimately, it’s the patient who suffers because of less timely access to care. And it leads to significant burnout and stress for staff in oncology clinics.
What Types Of Oncology Services Require Authorization?
In clinical oncology, there are many forms of treatment that range from CT scans and exploratory surgery to chemotherapy and patients undergoing hormonal maintenance therapy.
Here are just some of the main areas where prior authorization for cancer care is required:
- Radiology prior auths and imaging
- Intravenous chemotherapy
- Oral chemotherapy
- Radiotherapy
- Surgery
- Pain medicine prior authorization
- Hormone replacement therapy
- End-of-life care
Another issue that oncology clinics face is that cancer care is constantly evolving, with new drugs and treatments becoming available.
These new forms of treatments generally come with new and additional information required in order to process treatment-related prior authorization successfully.
All these factors lead to major challenges for oncologists and their support teams.
Challenges For Oncology Departments And Clinics
Let’s now take a closer look at the main challenges that oncology departments and clinics face when dealing with one of the most administratively demanding parts of the health care system.
An American Medical Association survey looked into the impact of prior authorization in the broader health care system by surveying doctors in a wide range of medical fields.
This research study revealed that the average doctor and their support staff spent over 16 hours per week on handling prior authorization requests and follow-ups. For a practice that has multiple providers they will need to assign a team of staff to exclusively handle prior authorizations.
That time poses a huge burden, especially when it comes to critical cancer care, where time is one luxury patients don’t have. What’s even more important is that oncologists are tied up in these hours of administrative work, which impacts their ability to focus on patients.
Our experience here at DataMatrix has been that oncology departments regularly experience denied authorizations because of missing or incorrect information.
It’s mainly due to the complexity of different submission forms, and these denied requests then often lead to many hours of research and phone calls to fix the problem.
Hospitals and clinics need large teams of highly experienced and trained teams to deal with this maze of requirements. And even then, admin teams generally struggle to stay on top of it.
The feedback we have received from oncologists and hospital management regarding the PA process is that it severely impacts how many patients each doctor can see.
It’s a simple matter of math to understand that even with an extremely long and stressful work week, an oncologist who has to spend 5–10 hours on the PA process can’t spend that time with patients.
As a result, physicians often find they have to shorten the average consultation time, which generally makes patients feel rushed and not properly served.
However, the more concerning issue is that even five hours freed up each week could take a couple of oncology patients off a waiting list.
There is also an impact of this reduced productivity on effectiveness and profitability. Making the most out of available funds and services is a critical consideration for both private and publicly owned hospitals.
The same study from the American Medical Association also looked at treatment delays the PA process caused.
33% of physicians said they regularly had to wait 1–2 business days to receive authorization, while 20% said they had to wait 3–5 business days. These waiting periods don’t even take into account the delays from requests for further information.
They are based on the initial decision response.
What this means is that rather than receive approval within 1–3 days, oncologists often have to tell their patients that they can’t start treatment or surgery immediately. For the likes of prostate, bowel, and breast cancer patients, this delay adds stress, anxiety, and the potential for a worse outcome.
Another research paper from the Memorial Sloan Kettering Cancer Center looked at the treatment impacts the PA process has.
The study found that in 22% of cases, patients didn’t receive the treatment recommended by physicians. Not only did this lead to potentially worse outcomes, but the process and common delays caused serious anxiety, and patients reported a distrust in the process.
One of the huge impacts that delays in oncology care have is the need for longer than necessary pain management. This additional treatment need can be noticed at different times for patients.
First of all, patients who are waiting for authorization for surgery or chemotherapy are often already in some level of discomfort and pain. The longer they have to wait before their treatment starts, the more they will need to rely on prescription pain medication.
Similarly, the longer physicians have to postpone treatment, the more invasive it may become. As a result, post-surgical or medical pain treatment can often be more severe.
The difficulty this increased need for medication poses is that doctors have to monitor the effects carefully to ensure their patients don’t become dependent on prescription drugs.
Benefits Of Outsourcing Prior Authorization Requirements
Through outsourced prior authorization services from DataMatrix, oncology departments and clinics can gain significant benefits. Over many years, we have learned that there are four main areas where our clients benefit the most.
While insurance companies implement prior authorization processes to improve utilization management in medical settings, the major difficulty lies in the fact that there is no consistent approach.
It means that admin teams have to be fully trained in a wide range of different systems, forms, and submission requirements.
Unfortunately, that complexity leads to inconsistent turnaround times and approvals from different insurers.
At DataMatrix, we focus on constant process improvement and training for our staff to ensure they fully understand the differences in submission forms. This approach allows us to achieve far higher rates of success with the first submission.
And we can achieve these results consistently with all insurers, further reducing the delay for patients.
As mentioned above, research has shown that a typical physician and their admin team will have to allocate over 16 hours a week to handle authorization requests.
While outsourcing the process still requires some work for clinical staff, there is no negative impact on the patient or caregiver involvement.
As a result, physicians and administrative staff save a lot of working time, not having to figure out authorization forms, research requests for more information, or spend hours on the phone waiting on hold.
Overall, our experience has been that doctors and admin teams become far more efficient with less burnout and stress.
In the medical oncology field, time is always critical. Whether it’s for getting initial tests and scans done or to start chemotherapy, oncologists simply don’t have the luxury to delay treatment.
With fewer delays and a far higher rate of successful authorizations with the first submission, doctors and patients can gain critical days to start a treatment program sooner.
This faster turnaround time then positively affects the overall outcome of treatments and has an impact on reduced stress and anxiety with patients who want to avoid long waiting times.
The final thing that all our clients experience is that with more time available to physicians and admin staff and the ability to get scans, tests, and treatments started sooner, there is a notable improvement in patient satisfaction.
Patients will not feel rushed or left waiting for longer than is necessary, and they will have more access to their physician.
All this creates a lot more confidence in doctors and the treatment, which leads to improved overall patient satisfaction.
Call Us To Find Out More About Outsourced Prior Authorization
Here at DataMatrix, we have built a large team of specialists with experience and extensive training in managing prior authorizations for oncology departments and clinics.
We have a proven track record of significantly reducing the turnaround time for authorization requests, and our processes free up your physicians and admin teams to focus on other, more urgent tasks.
Call us today for a free consultation, where we will explain the entire process and show you how quickly you could be making major improvements in your operational efficiency.
This will be one phone call you won’t regret making.
