Open Access Research article

Practice characteristics and prior authorization costs: secondary analysis of data collected by SALT-Net in 9 central New York primary care practices

John W Epling12, Emily M Mader1 and Christopher P Morley123*

Author Affiliations

1 Department of Family Medicine, SUNY Upstate Medical University, 750 E. Adams St., MIMC 200, Syracuse, NY 13066, USA

2 Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA

3 Department of Psychiatry & Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA

For all author emails, please log on.

BMC Health Services Research 2014, 14:109  doi:10.1186/1472-6963-14-109

Published: 6 March 2014

Abstract

Background

An increase in prior authorization (PA) requirements from health insurance companies is placing administrative and financial burdens on primary care offices across the United States. As time allocation for these cases continues to grow, physicians are concerned with additional workload and inefficiency in the workplace. The objective is to estimate the effects of practice characteristics on time spent per prior authorization request in primary care practices.

Methods

Secondary analysis was performed using data on nine primary care practices in Central New York. Practice characteristics and demographics were collected at the onset of the study. In addition, participants were instructed to complete an "event form" (EF) to document each prior authorization event during a 4–6 week period; prior authorizations included requests for medication as well as other health care services. Stepwise Ordinary Least Squares (OLS) Regression was used to model Time in Minutes of each event as an outcome of various factors.

Results

Prior authorization events (N = 435) took roughly 20 minutes to complete (beta = 20.017, p < .001); Medicaid requests took less time (beta = −6.085, p < .001), and Electronic Health Record (EHR) system use reduced prior authorization time by about 5 minutes (beta = −5.086, p = .002).

Conclusions

While prior authorization events impose substantial costs to primary care offices, it appears that Medicaid requests take less time than private payer requests. Results from the study provide support that Electronic Health Record usage may also reduce time required to complete prior authorization requests.