The American College of Radiology and other physician groups are urging the nation’s largest commercial insurer to reconsider “onerous” new prior authorization processes that recently took effect.
UnitedHealthcare began making providers jump through extra hoops on April 1 before they can obtain payment for certain outpatient services. Those include imaging-guided radiation therapy, along with fractionation for breast, prostate, lung and bone metastasis cancer.
ACR, the American Society for Radiation Oncology and the Association of Community Cancer Centers said they respect the insurer’s decision. But they are asking UnitedHealthcare to make modifications to lessen administrative burdens on busy physicians.
“We appreciate the need to curb services that are not medically necessary; however, we are concerned that the prior authorization tool contains onerous processes that will delay care for cancer patients,” the three wrote in an April 28 letter to Jennifer Malin, MD, PhD, the Minnesota-based payer’s medical director of oncology and genetics.
Following a recent demonstration of United’s new prior authorization portal, ACR and others advocated for several updates to simplify use. Streamlining the tool to remove any clinically irrelevant options is one choice, they wrote, along with only asking physicians to obtain very specific information that would trigger prior authorization. They additionally suggested exempting physicians with high rates of approval from these requirements when delivering standard oncology treatments.
“While addressing clinical and administrative concerns is vastly important, the most fundamental issue UHC must consider is the impact of the prior authorization tool on patients,” the doc groups wrote. “UHC can take meaningful steps toward reducing administrative burden by ensuring the prior authorization tool asks only those questions necessary to determine if the authorization request is appropriate,” they added later. “Anything beyond this only increases burden.”
You can read the full letter, signed by ASTRO CEO Laura Thevenot and American College of Radiology chief William Thorwarth Jr., MD, here. ACR also posted a news update on the issue Thursday.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.