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Prior authorizations for dermatology care nearly doubled in the last 2 years at one center



– Prior authorizations for the delivery of care in dermatology may be increasing steeply, judging from the experience of one large academic dermatology practice.

Ryan Carlisle of the University of Utah

Ryan Carlisle

“About the same number of patients were seen in 2018 as in 2016, but the number of prior authorizations required to serve those patients went up substantially,” reported Ryan P. Carlisle, a medical student who performed this analysis under the guidance of Aaron M. Secrest, MD, PhD, of the University of Utah, Salt Lake City.

Tracking of prior authorizations for the delivery of dermatologic care was initiated in 2016 at the University of Utah. By a number of measures, the burden of prior authorizations has been increasing steadily since that time, Mr. Carlisle said at the annual meeting of the Society for Investigative Dermatology.

As an example, one prior authorization was required for every 15 patient visits (6.7%) over a 30-day period in September 2016. In comparison, one prior authorization was required for every 9 patient visits (11.1%) in a comparable 30-day period in September 2018. Further, the number of clinic visits during this more recent period was 2.4% higher than in the earlier one (9,743 vs. 9,512), so the number of prior authorizations increased by 73.8% (1,088 vs. 626), Mr. Carlisle reported.

Two full-time staff and eight part-time staff at the University of Utah handle prior authorizations for 40 dermatologists and 10 nonphysician clinicians. The substantial unreimbursed costs incurred by this labor can be huge, he said. In one specific case, 81% of the reimbursed cost for a patient visit was consumed by seeking a prior authorization.

Of prior authorizations tracked at the University of Utah, 39.1% were for nonbiologic therapies, 21.6% were for excisions, 16% were for Moh’s surgery, 11% were for biologics, and the remainder was for an array of other procedures or therapies.

Of these, prior authorizations for biologics “were the most burdensome both in time and cost” on a per-visit basis, Mr. Carlisle reported.

The proportions of prior authorizations that were denied were relatively low. The highest proportion of denials was for nonbiologic medications (25%). The rate of denials for biologics over the study period was just 11%. Moreover, of denials that were appealed, 56% were granted.

Importantly, some prior authorizations were rarely denied. This includes a 0% denial rate for Moh’s surgery and a 1% denial rate for incisional procedures. Mr. Carlisle questioned whether the requirement for prior authorizations makes sense in these situations.

“Dermatology should partner with insurers to reduce unnecessary prior authorizations and appeals,” Mr. Carlisle suggested. It “is likely that these are affecting patient care” as well as ultimately, and perhaps unnecessarily, reducing reimbursement.

“The process to get prior authorizations completed and get patients their medications has just gotten to be too burdensome,” said Mr. Carlisle, summarizing the Utah experience.

SOURCE: Carlisle RP. SID 2019, Abstract 247.

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