Burden with No Benefit: Prior Authorization in Congenital Cardiology.

Autor: Marcus BS; Pediatric Cardiology, Yale School of Medicine, 205 Church Street, New Haven, CT, USA. brianmarcusmd@gmail.com.; Pediatric Critical Care, The Medical College of Wisconsin, Milwaukee, United States. brianmarcusmd@gmail.com., Bansal N; Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, New York, NY, USA., Saef J; Philadelphia Adult Congenital Heart Center, University of Pennsylvania, Philadelphia, PA, USA.; Heart Institute, Joe DiMaggio Childrens Hospital, Hollywood, Florida, USA., Fink C; Childrens Institute Department of Heart, Vascular & Thoracic, Division of Cardiology & Cardiovascular Medicine, Cleveland Clinic Children's Hospital, Cleveland, OH, USA., Patel A; Ann & Robert H. Lurie Childrens Hospital, Chicago, IL, USA.; Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Shaffer KD; Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Abilene, TX, USA., Mayer JE Jr; Department of Cardiac Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA., Johnson JN; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA., Shaffer K; Dell Medical School, University of Texas, Austin, TX, USA.; Pediatric and Congenital Cardiology Associates / Pediatrix Cardiology, Austin, TX, USA., Chowdhury D; Nemours Cardiac Center, Wilmington, DE, USA.; Cardiology Care for Children, Lancaster, PA, USA.
Jazyk: angličtina
Zdroj: Pediatric cardiology [Pediatr Cardiol] 2024 Jan; Vol. 45 (1), pp. 100-106. Date of Electronic Publication: 2023 Sep 26.
DOI: 10.1007/s00246-023-03255-1
Abstrakt: Prior authorization is a process that health insurance companies use to determine if a patient's health insurance will cover certain medical treatments, procedures, or medications. Prior authorization requests are common in adult congenital and pediatric cardiology (ACPC) due to need for advanced diagnostics, complex procedures, disease-specific medications, and the heterogeneity of the ACPC population. Prior authorizations in ACPC are rarely denied, but nonetheless, they are often accompanied by significant administrative burden on clinical care teams and delays in patient care. Prior authorizations have been implicated in worsening care inequities. The prior authorization process is insurer specific with differences between commercial and public insurers. Prior authorization rejections were previously found to be more common for women, racial minorities, those with low education, and in low-income groups. Prior authorization unduly burdens routine diagnostics, routine interventional and surgical procedures, and routine cardiac specific medication use in the ACPC population. This manuscript highlights the burdens of prior authorization and advocates for the elimination of prior authorization for ACPC patients.
(© 2023. The Author(s).)
Databáze: MEDLINE
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