B. U. Sidiqi1,2, C. Carpenter3, D. Pappas3, A. Pattison3, J. Hwang1,2, C. Evans1,2, L. Potters1,4, and W. C. Chen1,5; 1Northwell, New Hyde Park, NY, 2Department of Radiation Medicine, Northwell, New Hyde Park, NY, 3Siris Medical, Burlingame, CA, 4Department of Radiation Medicine, Northwell, New York, NY, 5Department of Radiation Medicine, Northwell, Bayshore, NY
Purpose/Objective(s): Radiation Oncology has the highest prior authorization burden across medical specialtiescausing significant patient delays and provider burden. While online portals exist, payer pre-authorization processes are poorly integrated into the clinical workflow and often require several iterations of communication while written payer policies are often unclear resulting in issued denials, patient delays and provider frustration. We hypothesized that a clinically integrated approval automation system would improve the authorization process by decreasing rates of denials, decreasing time to authorization and improving the provider burden. Materials/
Methods: We implemented InsightRT (Siris Medical, Division of TurningPoint Healthcare), an EMR integrated software system, to automate authorization documentation by capturing and transmitting patient and treatment characteristics. The online portal informed whether the treatment met payer policy and tracked the approval process. Policies for all national and local payers in this market were incorporated. We recorded median time to authorization and denial rates after implementation over a 3-month period from 9/2023-12/2023. For baseline median time to authorization, we compiled all cases from 1/2022 – 12/2023 across the department without software use. For baseline denial rate, we compared to historical controls from time periods where data was recorded: 1/2021 to 8/2021 and 12/2023 to 2/2024 for providers where the software was not utilized. User surveys were collected to measure the impact of InsightRT to the speed, ease, transparency, and user experience of prior authorization before and after implementation (scale: 1-5 (best)), and how likely users would recommend the InsightRT approach (scale: 1-10 (best)). Results: The software was implemented in 8 physician practices across 3 radiation centers compromising of community and central locations. A total of 454 cases were submitted on InsightRT with a denial rate of 1.5% compared to historical controls (n=1643), there was a significant reduction of denials from 9.9% to 1.5% (p < 0.001). Median time to authorization was decreased from 4.7 days to 3.6 days (24%) across all payers. For one top national payer, median time to authorization was reduced from 5.4 days to 2.5 days (53%). All 8 physicians continue to use the software.Nine users completed surveys (7 physicians, 8 billers/ administrators). Surveys across physicians showed satisfaction improvements with speed from 2 to 4; transparency from 1 to 5; ease from 1 to 4; user experience from 2 to 4; and recommendation of prior authorization system in place from 3 to 8. Conclusion: Early experience suggests that an integrated authorization automation software reduces rates of denials & delays in care, and improves provider satisfaction without changes in administrative burden. As utilization expands, longitudinal data will further quantify the impact to patient care and provider wellness.
