Multi-Stakeholder Perspectives on Prior Authorization Burden In Radiation Oncology
Abstract
Purpose
Prior authorization (PA) processes aim to promote utilization management and guideline adherence; however, national survey data from the American Society for Radiation Oncology (ASTRO) demonstrate negative impacts on radiation oncology practices, including treatment delays, administrative burden, deviations from guideline-concordant care, and clinician burnout. Prior studies have largely reflected physician-reported experiences and may overlook how PA burden affects the broader radiation oncology care team.
Methods
We conducted 20 open-ended qualitative interviews with stakeholders involved in radiation oncology PA workflows, radiation oncologists, medical physicists, radiation therapists, billing and revenue cycle staff, information technology and informatics leadership, departmental administrators, and external policy and industry-based experts. Interviews were conducted in person or via video conference and thematically analyzed to identify recurring PA-burden domains across stakeholder groups. Findings were interpreted in relation to published ASTRO PA survey results.
Results
Across 20 interviews representing 7 stakeholder groups, PA-burden emerged as a shared, systemic challenge. These findings confirm and strengthen challenges reported in the ASTRO survey, in which 91% of radiation oncologists reported PA-related treatment delays, 75% reported staff reallocation, 91% reported worsening burnout, and 58% reported deviations from national guidelines due to PA. Beyond physicians, documentation burden and medical necessity variability were identified by 6 of the 7 stakeholder groups. Workflow disruptions and Peer-to-Peer appeals, including repeated treatment planning and documentation revisions, were described by 6 groups. IT and data integration barriers were raised by 5 groups, while financial and procurement constraints were described by 4 groups.
Conclusion
Multi-stakeholder qualitative findings confirm and extend ASTRO survey results, demonstrating that PA-burden affects clinical care delivery, operations, and IT infrastructure. These descriptive findings support a multi-stakeholder consensus process to prioritize PA‑burden domains and identify feasible mitigation strategies.