by Jacqueline Renfrow |
Prior authorization is a major pain point for physicians—but emerging tech could help, according to new data.
In a case study of new prior authorization technology from Holon Solutions, a primary care provider in Fort Lauderdale, Florida, was able to cut the provider-to-payer process down to seconds instead of minutes. The study followed one primary care practice with two offices and three physicians.
According to a report written by the provider’s systems administrator, Kyle Knight, the office submits on average 600 referral prior authorizations per month. The practice is also involved in numerous value-based care programs, which further complicates their prior authorization needs.
Holon’s tool is part of an awareness platform that automatically offers data insights, such as flagging care gaps, within the provider’s EHR workflow.
“As primary care physicians in the managed care world, the physician is seen as the custodian of all the patient’s care and needs, while taking into account the cost of the care,” Knight told FierceHealthcare. “With this great responsibility, physicians have the satisfaction of knowing that their orders can easily be fulfilled without significant insurance red tape.”
Before implementing the context-sensing application, the referral authorization process had multiple steps and systems. Knight also called the process inefficient: a referral coordinator or an office manager would have to log onto the internet, onto a multipayer portal, search for a patient, type in information and then wait for the payer’s prior authorization to be assigned. And once returned, the office staff would have to enter the payer’s response back into the EHR.
“Ensuring efficiency and minimizing costly wasteful steps and rejected preauthorizations due to errors is crucial to improving reimbursement with this payer,” Knight wrote in the study. The new system allows staff to open the referral within the EHR and only requires one click on “request authorization code.”
While all this happens within seconds using Holon, the provider’s staff is still required to paste the prior authorization information into the EHR to complete the process.
“Even with that required step, manual searching, data entry and multiple clicks required for prior authorization requests have nearly been eliminated,” he said.
Beyond time savings, Knight notes that the new process has eliminated errors in the prior authorization process. In the case study, the office submitted 4,149 authorization requests in seven months and 96% were authorized. Only 3% were unauthorized by the payer due to ineligibility or other health plan restrictions, but not due to data errors.
Plus, Knight says that technology can play a significant role in helping to eliminate physician burnout.
“Physician burnout is often caused by the tedious process documenting their diagnoses,” Knight said. “In this case, physicians don’t get involved in the referral authorization process outside of writing orders,” which generally isn’t a problem in most EHRs.
A tech platform like Holon’s “helps with burnout in the same way it helps physicians serve their patients better. If the physician feels confident that their orders will be carried out exactly, this system indirectly improves physician burnout by allowing them to see their patient have a positive outcome. Doctors generally get a boost of confidence when patients have positive outcomes. After all, they didn’t become doctors to fill out paperwork,” he added.
The tool is also able to use multiple monitor setups for multiple users within the provider setting. Knight stresses that the technology makes employees feel more confident and organized in their work; therefore, employees are happier.
“And as for stats, extra monitor setups are extremely cheap when compared to the productivity boost,” he said.
Moving forward, EHRs will continue to play an important role in patient portals. At Knight’s office, patients have begun to provide their appointment dates for referrals via electronic message, and likewise, the patients have access to their referral history in a mobile and web app.
“EHRs and the connected portals are enabling patients to have access to their records so the patient will become more informed about their care and be better educated about their past medical history. Something that in the past, people often forget with time,” Knight said.