Evan Reeves, BS
Medical Student
University of Missouri School of Medicine
Columbia, Missouri, United States
William Shaw, DO
Assistant Professor of Clinical PM&R
University of Missouri School of Medicine
Columbia, Missouri, United States
Transitioning medically appropriate patients from an acute care facility to an inpatient rehabilitation facility (IPR) in an efficient manner benefits patients’ health and optimizes resource utilization for the larger healthcare system. In 2022, the U.S. average acute care length of stay was 4.6 days, compared to 5.8 days in 2023 at this acute care hospital (ACH). Increasing throughput for IPR placement allows for service to more patients. This study examines the impact of this ACH initiating prior authorizations for IPR placement.
Design:
Two groups of patients were compared retrospectively through an EMR review of potential IPR patient disposition outcomes, with the ACH initiating prior authorizations to a single insurance provider. Group 1 included the first 90 days of the intervention and group 2 the following 7 months. The approval rates were then compared to prior rates when outside facilities attempted authorization with the same insurer.
Results:
There were several differences in outcomes between the groups. The average insurance approval rate for IPR when initiated by the ACH was 53.4% for group 1 and 63.2% for group 2. This is an increased rate compared to when outside facilities requested authorization, which came with an initial approval rate of 46.6%. For unsuccessful authorizations, peer-to-peer conferences between facility physiatrists and insurance agencies had low success rates, with group 1 at 0% and group 2 at 3.1%. In group 1, 41% of patients pursued patient appeal for insurance approval after unsuccessful peer-to-peer conferences, contrasted to an increased rate of 64.5% in the group 2. The success rates of the patient appeal for insurance approval were similar between both groups, being 83% and 80%, respectfully.
Conclusions:
The intervention of the acute care hospital initiating prior authorizations demonstrates advantages. Increased initial approval rates reduce subsequent peer-to-peer conferences, patient appeals, length of stay, and assist with hospital throughput.
