Prior authorization is hurting patients and radiation oncologists, survey finds

Nearly all radiation oncologists agreed that prior authorization practices delay proper care for their cancer patients, according to a new survey of almost 700 specialists.

The survey was published by the American Society for Radiation Oncology (ASTRO) and collected online responses from 620 physicians in the ASTRO member database.

In addition to unanimously agreeing on delays, a third of radiation oncologists said those delays lasted longer than five days which is equal to a week-long regimen of standard radiation therapy. Each week of delay has been linked to a 1.2% to 3.2% increased risk of death, according to ASTRO.

“This survey makes clear that restrictive prior authorization practices can cause unnecessary, stressful and potentially life-threatening delays for cancer patients," said Paul Harari, MD, chair of the ASTRO Board of Directors, in a news release. "While the system may have been designed as a path to streamline and strengthen health care, it is in fact frequently harmful to patients receiving radiation therapy. In its current form, prior authorization causes immense anxiety and wastes precious time for cancer patients."

Below are some additional findings from the survey:

  • More than 73% of respondents said their patients regularly verbalize concern about delays in treatment, and 32% of radiation oncologists have used an alternate therapy for patients because of prior authorization holdups.
  • A majority (62%) of respondents said most prior authorization review denials are overturned after appeal. And 44% of specialists surveyed said their peer-reviews aren’t performed by a licensed radiation oncologist.
  • A total of 44% said they needed prior authorization for at least half of treatment recommendations, and 37% needed authorization for at least a quarter of their cases.
  • More than 60% needed to hire additional staff in the past year to manage the prior authorization process.

The American Medical Association and other medical societies recently joined ASTRO in sending a letter to CMS calling for Medicare Advantage plans to change their prior authorization requirements to those outlined in an industry-written consensus statement.

"Radiation oncology and cancer patients have been particularly hard hit by prior authorization's unnecessary burden and interference in care decisions," said Vivek Kavadi, MD, vice chair of ASTRO's Payer Relations Subcommittee, in the same release. "Radiation oncologists increasingly are restricted from exercising our clinical judgment in what is in the best interest of the patient, yet we are held accountable for the outcomes of treatments where decisions have been taken out of our hands."