Impact of insurance precertification on neurosurgery practice and health care delivery
| Autor: | Gary Jain, Anil Nanda, Jai Deep Thakur, Richard P. Menger |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Time Factors Back surgery media_common.quotation_subject Neurosurgical Procedures Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Denial Health care medicine Humans 030212 general & internal medicine media_common business.industry Insurance Surgical Authorization General Medicine medicine.disease United States Health care delivery Managed care Neurosurgery Medical emergency business Medicaid Delivery of Health Care 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurosurgery. 127(2) |
| ISSN: | 1933-0693 |
| Popis: | OBJECTIVEInsurance preauthorization is used as a third-party tool to reduce health care costs. Given the expansion of managed care, the impact of the insurance preauthorization process in delaying health care delivery warrants investigation through a diversified neurosurgery practice.METHODSData for 1985 patients were prospectively gathered over a 12-month period from July 1, 2014, until June 30, 2015. Information regarding attending, procedure, procedure type, insurance type, need for insurance approval, number of days for authorization, or insurance denial was obtained. Delay in authorization was defined as any wait period greater than 7 days. Some of the parameters were added retrospectively to enhance this study; hence, the total number of subjects may vary for different variables.RESULTSThe most common procedure was back surgery with instrumentation (28%). Most of the patients had commercial insurance (57%) while Medicaid was the least common (1%). Across all neurosurgery procedures, insurance authorization, on average, was delayed 9 days with commercial insurance, 10.7 days with Tricare insurance, 8.5 days with Medicare insurance, 11.5 days with Medicaid, and 14.4 days with workers' compensation. Two percent of all patients were denied insurance preauthorization without any statistical trend or association. Of the 1985 patients, 1045 (52.6%) patients had instrumentation procedures. Independent of insurance type, instrumentation procedures were more likely to have delays in authorization (p = 0.001). Independent of procedure type, patients with Tricare (military) insurance were more likely to have a delay in approval for surgery (p = 0.02). Predictably, Medicare insurance was protective against a delay in surgery (p = 0.001).CONCLUSIONSChoice of insurance provider and instrumentation procedures were independent risk factors for a delay in insurance preauthorization. Neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and interpret these data to deliver the best and most efficient care to our patients. |
| Databáze: | OpenAIRE |
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