If Medicare Part B spending were subject to private insurers' prior authorization rules, 2.2 services per beneficiary per year would require prior authorization, according to an investigation published in JAMA Health Forum.
Medicare Part B does not require prior authorization. Researchers from the Philadelphia-based University of Pennsylvania's medical school analyzed fee-for-service claims for Medicare Part B beneficiaries in 2017.
The study found that 25 percent of the program's spending would require prior authorization if operating under the typical coverage rules of large Medicare Advantage plans. It also found more than 40 percent of the 6.5 million beneficiaries received at least one service per year that would require prior authorization.
Specialists whose services required prior authorization most were radiation oncologists (97 percent), cardiologists (93 percent) and radiologists (91 percent). The lowest preauthorization rates were among psychiatrists (4 percent) and pathologists (2 percent.).
The researchers said more data is needed to determine if this finding translates to savings for insurers.
"An overarching theme in health policy is that American healthcare is expensive and one way to reduce costs is eliminating procedures that aren’t necessary," Aaron Schwartz, MD, PhD, the study's lead author, said in a news release. "Insurers can set rules about when a service is medically necessary and ensure that a planned medical service satisfies those rules before it occurs. Physicians may consider this step a burdensome hurdle. But, insurers may argue it is necessary to reduce unneeded spending."