Implementation of a streamlined prior authorization process to improve cancer care delivery.

Abstract

1531 Background: Prior authorizations (PAs) for systemic cancer treatments are increasingly becoming a barrier to timely quality cancer care delivery. There is an extraordinary administrative burden placed on clinicians to complete peer to peers (P2P) and appeals when authorization specialists are unable to identify appropriate clinical data in the EHRs. This leads to delays in care, staff burnout and loss of revenue. At our tertiary academic cancer center, in partnership with our cancer registry and Epic teams, we propose shifting the clerical work required for intravenous chemotherapy PAs from clinicians to certified tumor registrars (CTRs) to improve documentation needed for authorization specialists and decrease PA associated clinician burnout. Methods: Clinicians first place the treatment plan order which goes to the CTR work queue. We leveraged the Epic staging smart form to consolidate and auto-populate a list of common data elements needed for PA (performance status, cancer biomarkers, stage, line of treatment, and goals of treatment). The CTRs then complete and validate all elements necessary for authorization specialists to obtain the PA. Our primary outcomes include: average monthly number of intravenous chemotherapy authorizations pending review (including P2P, appeals and authorizations requiring other clinical interventions from the primary team) during a pre (9/1/2021-9/30/22) and post-implementation (11/14/22-1/30/23) period. Analyses were conducted using descriptive statistics. Results: The average monthly number of authorizations pending review was 332 pre-implementation and 227 post-implementation, which is a 32% reduction. To account for temporal changes, when comparing December 2021 to January 2022 vs December 2022 and January 2023, the average number of referrals pending review was 276 vs 227 which is an 18% reduction. First line treatment regimens accounted for most regimens requiring review; 28% and 27% pre-implementation and post-implementation, respectively. Non-chemotherapeutics like lanreotide and feraheme had the highest pending review status pre-and post-implementation respectively. Among chemo/immunotherapeutics, Nivolumab and Trastuzumab deruxtecan had the highest pending review status pre and post implementation, respectively. GI regimens had the highest number of regimens requiring review accounting for 17% vs 22% of all referrals pre and post implementation, respectively. Conclusions: By leveraging technology and increasing efficiencies of existing non-clinical staff workflows, we significantly decreased the number of ambulatory chemotherapy PAs that required further clinical review including P2P and appeals thereby improving efficient care delivery. Next steps include evaluation of sustained improvement, time to final authorization, revenue analysis and the impact on the well-being of clinicians.