APPs Report High Levels of Prior Authorization-Related Burnout

Jessica Royer, AGPCNP-BC

According to a poster presented at the 2023 ASCO Quality Care Symposium, advanced practice providers (APPs) and physicians are deeply affected by prior authorization requests.

“Oncology physicians and APPs report high baseline rates of burnout and dedicate a significant portion of the week to completing prior authorizations,” Jessica Royer, AGPCNP-BC, a nurse practitioner with the Icahn School of Medicine at Mount Sinai, and coinvestigators wrote. “Importantly, APPs perceived the prior authorizations to have a high impact on their burnout compared to physicians.”

Key Findings

Ultimately, 35 physicians and 21 APPs responded to the survey. On average, physicians and APPs shared that they conduct 6 and 3 prior authorizations, respectively, every week. Physicians reported spending a median of 5 hours per week on prior authorizations, and APPs spend 2 hours a week. Yet, APPs reported a higher overall perception of burnout related to prior authorizations. On a rating scale from 0 to 100, physicians reported that prior authorizations had a 13.5 impact on burnout and APPs reported a 53.5 impact.

According to their Copenhagen Burnout Score, more APPs reported that prior authorizations were causing them burnout (64.28; IQR, 50.83.0)compared to theirphysician colleagues (46.43; IQR, 35.71-60.71).

Among physicians, females were more likely to report a correlation between prior authorizations and burnout (53.57 (IQR, 35.71-64.29) compared with male colleagues (42.86; IQR, 35.71-56.25). There were also differences between those who had been practicing for fewer than 15 years (53.57; IQR, 42.86-60.71)vs more than 15 years (37.5; IQR, 28.5756.25), as well as among those who spent more than 60% of their time directly interacting with patients (53.57; IQR, 39.29-60.71) vs less than 60% of their time directly interacting with patients (42.86 (33.03-62.5).

Among APPs, those with less than 5 years of clinical practice experience were more likely to report high burnout (71.43; IQR, 60.71-85.71) than those with more than 5 years’ experience (50; IQR, 46.3-63.4).

Methodology

All hematology-oncology faculty and APPs working at Mount Sinai’s largest clinical site were asked to complete a baseline wellness survey. The questions included in the survey were selected from the American Medical Association surveys; the questions queried about the clinician’s perceptions on prior authorizations, their impact on clinical workloads, and how they affected care delivery. Both the physicians and the APPs were asked to rate, 0-100, how much prior authorizations impact burnout.

Burnout was the study’s primary outcome and it was evaluated using the work-related Copenhagen Burnout Inventory. Descriptive statistics were used to help conduct the analysis.

Significance

As the authors explain in the poster, the burden of prior authorizations required for costly oncologic treatments is high. When prior authorizations are denied, clinicians must engage in peer-to-peer requests. These requests are time consuming and require effort on behalf of the physician and advanced practice provide that otherwise could be directed towards patient care.

The results from this study will be used to inform a new process that will streamline the prior authorization process. The new system will use a single electronic medical record platform for finance and cancer registry teams.

Reference

Pintova S, Royer J, Sheng T, et al. Better together: a team-based approach to improve prior authorization efficiencies and wellness in physicians and advanced care providers. Presented at: ASCO Quality Care Symposium. October 27-28, 2023; Boston, MA.