Digital Health Innovation and Informatics

PV QA 2 - Poster Viewing Q&A 2

MO_18_2479 - Simulation Order for Patients Undergoing Robotic-based SBRT: Identifying Predictors of Lengthier Insurance Authorization

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Simulation Order for Patients Undergoing Robotic-based SBRT: Identifying Predictors of Lengthier Insurance Authorization
S. R. Blacksburg, A. Mirza, G. Demircioglu, T. J. Carpenter, M. R. Witten, J. Morgenstern, D. W. Ebling, D. Catell, E. Castellano, D. Accordino, M. Oliveri, M. Giambona, S. Lowery, and J. A. Haas; NYU Winthrop Hospital, Mineola, NY

Purpose/Objective(s): Delivering Stereotactic Body Radiation Therapy (SBRT) requires the integration of several time-sensitive steps. In some disease states, delay to treatment has been found to impact clinical outcome. Obtaining insurance authorization is a critical initial task to mitigate against patient financial hardship. Despite this, there is a paucity of literature identifying predictors of protracted insurance authorization for patients who receive robotic-based SBRT. This study explores factors that influence time from simulation order to insurance authorization at a busy hospital practice.

Materials/Methods: We conducted a retrospective review of simulation order requests for patients undergoing robotic-based SBRT during the year 2017. We queried data fields that included insurance type, treatment site, and fractionation request. Insurance categories included Medicare, Medicaid, Commercial, and Self-Pay. These fields were cross referenced with time stamps of the simulation order and insurance authorization date.

Results: From January 4, 2017 to December 29, 2017, 583 consecutive simulations were ordered for robotic-based SBRT. Patient insurance included Medicare (36.7%); Medicaid (0.1%) Commercial (60.9%); and (2.1%) patients self-paid. The most common treatment sites were prostate (60.9%), lung (10.1%), and brain (10.1%). Mean time to insurance authorization was 10 days (0-105). 13.4% of cases took >20 days for insurance authorization and 7.5% of cases took >30 days. Commercial insurance carrier predicted for longer mean authorization time compared to Medicare or Medicaid insurance (13.5d vs. 4.1d and 4.0d, p<.0001). Insurance approval for robotic-SBRT was considerably shorter for cases involving brain, lung, and spine sites than for prostate (3.8d, 3.4d, 4.0d vs. 12.0d, p<.0001). Single fraction cases were approved more expeditiously than cases involving 2-5 or >5 fraction sizes (3.8d vs. 10.2d and 16.8d, p=.03). Predictors of time >5days for authorization included Commercial vs. Medicare insurance (56.3% vs. 13.1%, p<.0001), prostate vs. lung and brain cases (45.1% vs. 18.6% and 27.1%, p<.0001), and 5 fraction vs. 1 fraction cases (66.7% vs. 20.7%, p=.005). On multivariate analysis, predictors of longer insurance authorization included non-Medicare insurance (OR 10.2, CI 2.7-40.0, p=.001) and treatment with ≥5 fractions (OR 3.8, CI 1.2-11.9, p=.02).

Conclusion: Most patients attain insurance authorization for robotic-based SBRT within 2 weeks’ time from simulation order. Factors contributing to delay to insurance authorization include non-Medicare carriers as well as ≥5 fraction size. Further study is warranted to prospectively assess whether incorporating this information into dynamic workflow can improve clinical efficiency.

Author Disclosure: S.R. Blacksburg: None. A. Mirza: None. G. Demircioglu: None. M.R. Witten: Consultant; accuray. D.W. Ebling: None. D. Catell: None. E. Castellano: None. D. Accordino: None. M. Oliveri: None. J.A. Haas: Consultant; accuray.

Seth Blacksburg, MD, MBA

NYU Winthrop Hospital

Disclosure:
Employment
none: none

Compensation
Accuray: Speaker's Bureau

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