Prior authorization is standard practice in healthcare and is used as a cost-control method. In essence, it is the process where a healthcare provider has to get approval from a payer before certain treatments or medications are given to patients.
This utilization management process aims to control costs but creates major headaches for healthcare providers and front-desk staff. Recently, there's been an increasing trend toward employing this strategy within dermatology practices owing to the rising price of cutting-edge but costly dermatologic medications.
Adonis offers tech-enabled solutions to streamline cumbersome prior authorization processes. This article will discuss the current difficulties faced by healthcare providers in dermatology due to prior authorizations and propose solutions that could streamline this process.
How Prior Authorization Affects Dermatology Practices
In dermatology, prior authorizations are frequently required for expensive drugs like biologics. However, many practices report it's now needed even for inexpensive, commonly prescribed treatments.
One study found the volume of prior authorization (PA) requests at an academic dermatology clinic increased by 73.8% between 2016 and 2018, while patient visits only rose 2.4%. This shows how quickly prior authorization requirements are expanding.
Prior authorizations create pain points, including:
- Major Administrative Burdens: A survey found the average dermatology practice receives 420 PA requests annually. Processing these consumes significant staff time and resources. 60% of dermatologists have had to interrupt visits to deal with prior authorization demands.
- Disruptions to Care: 17% of dermatologists said PA has led them to prescribe less effective treatments. 12% indicated patients had delayed or abandoned care due to PA issues. Even short delays can worsen outcomes.
- Outdated Formularies: Many dermatologists express frustration with formularies that lack newer, more effective medications. Developed without specialist input, formularies often dictate the use of older, less optimal treatments.
- High Denial Rates: A 2020 study found a 51% denial rate for complex dermatology requests. Repeated denials create further delays and are a major headache.
How Patients Are Impacted
This bottlenecked process doesn't only strain dermatologists and their teams but also significantly impacts patients needing these treatments. Prior authorization also negatively affects patients through:
- Delays in Accessing Optimal Treatment: The inevitable extended turnaround times make it increasingly challenging for patients to immediately access needed medications upon prescription. With many opting to abandon their course due to frustrations with delayed outcomes, worsening conditions are starting to become commonplace.
- Treatment Barriers: Restrictive formularies make it hard to access optimal medications. 20% of patients cited PA issues for not adhering to acne treatment.
- Increased Costs: When newer treatments aren't covered, patients pay more out-of-pocket costs. Treatment delays lead to avoidable hospitalizations, which further drive up expenses.
- Lack of Transparency: Patients receive little explanation when requests are denied. This lack of transparency into why treatment is being restricted can damage the physician-patient relationship.
Opportunities for Improvement
All these issues necessitate comprehensive reform - one designed toward mitigating medical billing challenges facing today's healthcare providers in dermatology.
Specialist Input into Formulary Decisions
The process could become smoother if dermatology practitioners share insights with payers on which medications best serve different patient demographics. This would ensure formularies stay current with newer approved drugs, effectively reducing the amount of denied prior authorization requests.
Clear Rationale and Appeals Process for Denials
To further streamline the process, a clear and well-outlined rationale behind denials could be beneficial for all parties involved. Additionally, having a transparent and systematically designed appeal process would cut down time spent on conflicts after initial denials.
Leveraging Technology to Modernize and Streamline
Technological enhancements seem the most promising solution to circumvent these imposing challenges. By automating some administrative tasks, we'd relieve much of the burdens on healthcare providers maneuvering prior authorizations in their day-to-day operations. Improved communications between payers and providers will likely diminish confusion surrounding denied claims, too.
How Adonis Streamlines Prior Authorization
Adonis is an intelligent platform that integrates with EHRs to automate cumbersome prior authorization workflows. Key features include:
- Payer Communications: Enables direct communication with payers within EHRs to resolve issues faster.
- Real-Time Tracking: Customizable dashboards provide visibility into pending requests.
- Status Updates: Automatic notifications when a prior authorization status changes let practices respond promptly.
- Patient Access: Streamlines prior authorizations for new patients or complex procedures to increase revenue while decreasing costs.
Through artificial intelligence and machine learning, Adonis reduces frustrations and allows dermatology practices to focus on delivering excellent patient care.
Conclusion
In its current state, the prior authorization process in dermatology is untenable for practices, physicians, and patients. Innovative solutions like Adonis offer a high-tech fix by automating inefficient manual workflows. Get started today.
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