Better Together: A team-based approach to improve prior authorization efficiencies and wellness in physicians and advanced care providers.

Authors

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Sofya Pintova

Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY

Sofya Pintova, Jessica Royer, Tianxiang Sheng, Mark Liu, Alana Noble-Kirk, Cardinale B. Smith, Aarti Sonia Bhardwaj

Organizations

Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, Icahn School of Medicine at Mount Sinai, New York, NY, Mount Sinai Health System, New York, NY

Research Funding

Other
Mount Sinai Office of Wellbeing and Resilience

Background: The burden of prior authorizations (PAs) required for costly oncologic treatments is high. Upon PA denials, peer-to-peer requests are performed. These requests consume time and effort of physicians and advanced care providers (APPs) contributing to burnout and may have a negative impact on patient care. We aimed to assess the degree to which the PA process contributed to burnout among oncology clinicians prior to implementation of a new streamlined workflow aimed at improving clinician wellness. Methods: A baseline wellness survey was sent to all hematology-oncology faculty and APPs at the largest clinical site of our academic cancer center. Burn out, our primary outcome, was measured using the work-related Copenhagen Burnout Inventory. We included selected questions from the American Medical Association (AMA) surveys regarding physician perceived impact of PAs on clinical workload and care delivery. We asked physicians and APPs to rate the impact of PAs on burnout on a scale of 0-100. Analysis was conducted using descriptive statistics. This study was sponsored by our Office of Well-Being and Resilience. Results: The wellness survey was completed by 35 physicians and 21 APPs with a response rate of 53% in both (Table). The median Copenhagen burnout score for physicians was 46.43 (35.71-60.71) with higher burn out scores among those identifying as females, in practice less than 15 years and with more than 60% time in direct patient care. The median burn out score for APPs was 64.28 (50-83.03). Similar to physicians, APPs with less clinical experience had higher burn out scores. When asked about the impact of PAs on burnout, physicians reported a lower median of 13.5 (5.5-40.25), compared to APPs who reported a median of 53.5 (24-68.25). Conclusions: Physicians and APPs report high baseline rates of burnout and dedicate a significant portion of the week to completing PAs. Importantly, APPs perceived the PAs to have a high impact on their burn out compared to physicians. We will use these data to determine the efficacy of a new process that utilizes a single EMR platform for finance and cancer registry teams to abstract and document all of the required elements to streamline the PA process for intravenous/injection cancer treatments with the goal to reduce the number of PAs and improve wellness.

Median burn out scores and PAs.

Burn Out Score
(IQR)
#PAs Prior Week
(IQR)
# Hours Spent on
PAs (IQR)
Impact of PAs on Burn Out (scale 0-100)
(IQR)
Physicians46.43 (35.71-60.71)6 (3.5-13.5)5 (3-9.75)13.5 (5.5-40.25)
Male42.86 (35.71-56.25)
Female53.57 (35.71-64.29)
>15 years in practice37.5 (28.57-56.25)
<15 years in practice53.57 (42.86-60.71)
>60% in direct patient care53.57 (39.29-60.71)
<60% in direct patient care42.86 (33.03-62.5)
APPs64.28 (50-83.03)3 (1-4)2 (1-4)53.5 (24-68.25)
>5 years in practice 50 (46.43-63.4)
<5 years in practice 71.43 (60.71-85.71)

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Abstract Details

Meeting

2023 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Quality, Safety, and Implementation Science,Cost, Value, and Policy,Patient Experience,Survivorship

Sub Track

Team-Based Approaches to Care Delivery

Citation

JCO Oncol Pract 19, 2023 (suppl 11; abstr 55)

DOI

10.1200/OP.2023.19.11_suppl.55

Abstract #

55

Poster Bd #

C8

Abstract Disclosures

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