News | Radiation Therapy | April 26, 2019

Radiation Oncologists Say Prior Authorization Delays Patient Access to Cancer Treatments

2018 ASTRO survey shows practicing radiation oncologists believe prior authorization adds to patient, physician stress

Radiation Oncologists Say Prior Authorization Delays Patient Access to Cancer Treatments

April 26, 2019 — Restrictive prior authorization practices cause unnecessary delays and interference in care decisions for cancer patients, according to a new survey of nearly 700 radiation oncologists — released by the American Society for Radiation Oncology (ASTRO).

Nearly all radiation oncologists (93 percent) said that their patients are delayed from life-saving treatments, and a third (31 percent) said the average delay lasts longer than five days – a full week of standard radiation treatments. These delays cause added stress and anxiety to patients already concerned about their health. They are cause for alarm given research linking each week of delay in starting cancer therapy with a 1.2 percent to 3.2 percent increased risk of death.

In addition to prevalent treatment delays, the ASTRO physician survey illuminates other ways prior authorization negatively impacts patient outcomes and takes physicians away from caring for their patients:

Added Patient Stress

  • More than 7 in 10 radiation oncologists (73 percent) said their patients regularly express concern to them about the delay caused by prior authorization;
  • More than 3 in 10 radiation oncologists (32 percent) have been forced to use a different therapy for a substantial number of their patients (>10 percent) due to prior authorizations delays.

Unnecessary Delay Tactics

  • Nearly two-thirds of radiation oncologists (62 percent) said most denials they receive from prior authorization review are overturned on appeal;
  • Radiation oncology benefit management companies (ROBMs) required 85 percent of radiation oncologists to generate multiple treatment plans, which require physicians and medical physicists to spend several hours developing alternatives to their recommended course of treatment;
  • More than 4 in 10 respondents (44 percent) said their peer reviews typically are not conducted by a licensed radiation oncologist.

Wasting Physician Time

  • Nearly one in five radiation oncologists (17 percent) said they lose more than 10 percent of time that they could be caring for their patients focused instead on dealing with prior authorization issues. An additional 39 percent spend 5-10 percent of their average workday on prior authorization;
  • More than 4 in 10 radiation oncologists (44 percent) needed prior authorization for at least half of their treatment recommendations. An additional third (37 percent) needed it for at least a quarter of their cases;
  • Many radiation oncologists (63 percent) had to hire additional staff in the last year to manage the prior authorization process.

Disproportionate Impact on Patients at Community-Based Clinics

  • Patients treated at community-based, private practices experience longer delays than those seen at academic centers. For example, average treatment delays lasting longer than a week were reported by 34 percent of private practitioners vs. 28 percent of academic physicians (p=0.005);
  • Radiation oncologists in private practice are almost twice as likely to spend more than 10 percent of their day focused on prior authorization, compared to physicians at academic centers (23 percent vs. 13 percent, p=0.003)

“This survey makes clear that restrictive prior authorization practices can cause unnecessary, stressful and potentially life-threatening delays for cancer patients,” said Paul Harari, M.D., FASTRO, chair of the ASTRO board of directors and professor and chairman of human oncology at the University of Wisconsin-Madison. "While the system may have been designed as a path to streamline and strengthen healthcare, 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.”

“Radiation oncology and cancer patients have been particularly hard hit by prior authorization’s unnecessary burden and interference in care decisions,” said Vivek Kavadi, M.D., vice chair of ASTRO’s Payer Relations Subcommittee and a radiation oncologist at Texas Oncology. “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.”

In the 2018 annual ASTRO member survey, radiation oncologists named prior authorization as the greatest challenge facing the field. The burden was especially prominent among private practitioners in community-based settings, where the majority of cancer patients receive care.

An online survey was sent by email to all 3,882 U.S.-based, practicing radiation oncologists in ASTRO’s member database, and 620 physicians completed the survey online. Invitations were sent in December 2018, with one email reminder in January 2019, and the survey closed in February 2019. ASTRO staff also administered paper surveys at the ASTRO Annual Meeting in October 2018 and collected 53 responses. Findings reflect the combined total of 673 radiation oncologist responses.

The findings from ASTRO’s new physician survey align with recent reports from the American Medical Association (AMA), American Cancer Society Cancer Action Network (ACS CAN) and others, demonstrating the pervasiveness of prior authorization obstacles throughout the American healthcare system.

ASTRO recently signed onto a letter with the AMA and other medical societies calling for the Centers for Medicare and Medicaid Services (CMS) to require Medicare Advantage plans to align their prior authorization requirements with a Consensus Statement on Improving the Prior Authorization Process authored jointly by leading provider and payer organizations.

Read the executive summary of the ASTRO survey

For more information: www.astro.org

Related Content

According to the new market research report "Radiation Dose Management Market by Products & Services (Standalone Solutions, Integrated Solutions, Services), Modality (Computed Tomography, Nuclear Medicine), Application (Oncology, Cardiology, Orthopedic), End User (Hospitals) - Global Forecast to 2025", published by MarketsandMarkets, the radiation dose management market is projected to reach USD 422.65 million by 2025 from USD 220.22 million in 2020, at a CAGR of 13.9%.

Courtesy of MarketsandMarkets Research

News | Radiation Dose Management | August 03, 2020
August 3, 2020 — According to the new market research report "...
Siemens AG is continuing to rigorously execute its Vision 2020+ strategy and therefore expressly welcomes Siemens Healthineers AG’s acquisition of a 100 percent stake in Varian Medical Systems, Inc., a U.S. company active in the area of cancer research and therapy.

Getty Images

News | Radiology Business | August 03, 2020
August 3, 2020 — Siemens AG is continuing to rigorously execute its Vision 2020+ strategy and therefore expressly wel
JAMA Oncol. Published online  July 30, 2020. doi:10.1001/jamaoncol.2020.2783

Table 1. JAMA Oncol. Published online  July 30, 2020. doi:10.1001/jamaoncol.2020.2783

News | Coronavirus (COVID-19) | July 31, 2020
July 31, 2020 — An article published in JAMA...
Older Americans may be receiving cancer screenings not recommended by the U.S. Preventive Services Task Force, according to Penn State College of Medicine researchers.

Getty Images

News | Radiology Imaging | July 31, 2020
July 31, 2020 — Older Americans may be receiving cancer screenings not recommended by the...
It has been estimated that the overwhelming focus on COVID-19 could cause up to 35,000 excess cancer deaths in the UK during the next 12 months, and  Zegami, the Oxford University data visualization spin-out which has worked on several projects focused on the detection, diagnosis, or management of cancer, is calling for greater use of technology to speed up the process of diagnosis and treatment.

Getty Images

News | Radiation Oncology | July 29, 2020
July 29, 2020 — It has been estimated that the overwhelming focus on...
Prostate biopsy with cancer probability (blue is low, red is high). This case was originally diagnosed as benign but changed to cancer upon further review. The AI accurately detected cancer in this tricky case. Image courtesy of Ibex Medical Analytics

Prostate biopsy with cancer probability (blue is low, red is high). This case was originally diagnosed as benign but changed to cancer upon further review. The AI accurately detected cancer in this tricky case. Image courtesy of Ibex Medical Analytics

News | Prostate Cancer | July 28, 2020
July 28, 2020 — A study published in 
Zebra Medical Vision announced its sixth FDA 510(k) clearance for its mammography solution, HealthMammo, which has already received a CE mark. Zebra Medical’s algorithm empowers breast radiologists by prioritizing and identifying suspicious mammograms, providing a safety net for radiologists. The suspicious mammograms are identified faster and read earlier than the current “first-in first-out” standard of care. 
News | Breast Imaging | July 27, 2020
July 26, 2020 —  Zebra Medical Vision announced its sixth FDA 510
(a) A schematic of cycloidal computed tomography (not to scale, seen from top); by adding an array of beam stops in front of the detector, the setup is transformed into an edge-illumination x-ray phase-contrast imaging device. (b) A sinogram sampling grid for a rotation-only scheme. (c) A sinogram sampling grid for a cycloidal scheme. The grids are shown for one mask period and a subset of rotation angles; the combination of empty and filled circles shows the grids that would be achieved through fine latera

(a) A schematic of cycloidal computed tomography (not to scale, seen from top); by adding an array of beam stops in front of the detector, the setup is transformed into an edge-illumination x-ray phase-contrast imaging device. (b) A sinogram sampling grid for a rotation-only scheme. (c) A sinogram sampling grid for a cycloidal scheme. The grids are shown for one mask period and a subset of rotation angles; the combination of empty and filled circles shows the grids that would be achieved through fine lateral sampling (requiring dithering); the filled circles show the data that are sampled without dithering.

News | Computed Tomography (CT) | July 24, 2020
July 24, 2020 — A computed tomography (CT) sca
In I-131 cancer therapy, decay events damage sensitive DNA within a tumor cell nucleus, causing catastrophic single and double strand breaks. Clinical use of antibody-delivered Auger emitters could open a window for the targeted destruction of extracellular COVID-19 virions, decreasing the viral load during active infection and potentially easing the disease burden for a patient. View all figures from this study.  http://jnm.snmjournals.org/content/early/2020/07/16/jnumed.120.249748.full.pdf+html

In I-131 cancer therapy, decay events damage sensitive DNA within a tumor cell nucleus, causing catastrophic single and double strand breaks. Clinical use of antibody-delivered Auger emitters could open a window for the targeted destruction of extracellular COVID-19 virions, decreasing the viral load during active infection and potentially easing the disease burden for a patient. View all figures from this study.

 

News | Coronavirus (COVID-19) | July 22, 2020 | Dave Fornell, Editor
July 22, 2020 — One of the first studies has been published that looks at the use of...