Date of Award

January 2021

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jonathan N. Grauer

Abstract

Introduction

Preauthorizations are frequently required by commercial insurers before patients can undergo magnetic resonance imaging (MRI) of the spine. In addition to the administrative burden, such processes can lead to delays in care. The current study assessed the rates and eventual disposition of preauthorizations required prior to spine MRIs ordered from an academic spine center.

Methods

Patients from a single academic institution’s spine center who were covered by commercial insurance and referred for a spine MRI between January 2013 and December 2019 were included in the analysis. The requirement for preauthorization and eventual disposition of each of these studies was tracked. Multivariate logistic regressions were then used to determine if commercial insurance carrier or anatomic region of requested MRIs were associated with requiring a preauthorization.

Results

In total, 2,480 MRI requests were included in the analysis. Of these, preauthorization was needed for 2,122 (85.56%). Of the studies requiring a preauthorization, peer to peer was required for 204 (8.23% of the total studies ordered) (Figure 1).

Of the studies requiring preauthorization, 375 (17.67%) were initially cancelled or denied. Of those denied, 204 underwent peer to peer review, and 59 (28.92%) of those peer to peer requests were denied or cancelled.

Of the cancelled or denied studies, 290 (77.33%) went on to be completed within three months. In total, only 85 (3.43% of the originally ordered MRIs) were not eventually approved and completed.

Relative to the control insurer, four of the five commercial carriers had statistically significant increased odds of requiring preauthorization (OR=1.54 to 10.17 p<0.050). Relative to cervical spine scans, preauthorization was required more for thoracic (OR=2.71, p=0.003) and lumbar (OR=2.46, p<0.001) regions.

Discussion/Conclusion

Of 2480 distinct MRI orders, commercial insurers required preauthorization for 85.56% and peer to peer for 204 (8.23% of the total scans ordered). Nonetheless 2395 (96.57%) of the scans went on to be completed, and only 85 (3.43%) were not completed. Further research on the costs and benefits of this administrative paradigm is encouraged.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 10/12/2022

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