Speaker: Elizabeth Abe, BS, Research Fellow, Rothman Orthopaedic Institute
Elizabeth Abe, BS: Hi, my name is Elizabeth Abe. I'm currently a 4th year medical student. The study that I worked on was done between 3rd and 4th year at Rothman as a research fellow with Doctor Courtney and Doctor Krueger.
Study Introduction & Objectives
Elizabeth Abe, BS: The purpose of our study was to determine the efficacy of prior authorization to reduce costs, while still ensuring that patients are appropriately approved for a total hip replacement, especially since we know that hip replacements are cost effective and definitive management options for patients with severe hip osteoarthritis. We chose to quantify the time and costs associated with failing conservative treatment in patients with severe hip osteoarthritis that had insurance that required prior authorization prior to a total hip replacement, and compared that to the time and cost of patients that underwent a hip replacement without any prior authorization requiring insurance carriers.
Key Takeaways & Discussion Points
Elizabeth Abe, BS: We found that in our study, obtaining prior authorization from private payers for patients undergoing a total hip replacement had no cost saving benefits when compared to patients with payers that did not require prior authorization and both the year prior to a total hip arthroplasty and from the time that a patient requested to have surgery to the day of their hip replacement. Instead, we found that patients with prior authorization waited longer to undergo surgery and had significantly lower preoperative outcome scores when compared to patients without. So the use of prior authorization as a cost-reduction reduction strategy should be reconsidered as patients waited longer and were worse off prior to surgery, when compared to patients that did not have prior authorization requiring carriers.
Impact on Patient Care
Elizabeth Abe, BS: The study has the potential to impact future patient care by advocating against the use of prior authorization. Though it's becoming incredibly more common from insurance carriers, we were able to show that the use of prior authorization, 1) does not reduce any healthcare spending. No patients in our study were completely turned away from surgery. Instead, it created delays to care and increased the time that patients spent waiting to undergo surgery. And 2), we were able to show that using prior authorization to have patients trial and subsequently fail non-operative management, increase their cost of care, and also did not have a positive impact on their outcome scores preoperatively, which we know has previously been shown in studies to be correlated to negatively impact postoperative outcome scores.
