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1 Million Hours of Psychiatrist Time Wasted Yearly on Phone Approvals for Hospitalization

Harvard researchers find lengthy waits for severely ill psychiatric patients (Apr. 23)

A study published in the Annals of Emergency Medicine reports lengthy waits for severely ill psychiatric patients in need of immediate hospitalization in the Boston area, due in part to time-consuming prior authorizations required by insurance companies.

Psychiatrists spent, on average, 38 minutes on the telephone acquiring authorization. In 10% of cases, it took more than 1 hour to obtain insurance authorization, and in one case, authorization took 5 hours of psychiatrist time, according to the study.

Over a 3-month period, researchers tabulated how long psychiatric patients who were deemed in need of inpatient admission stayed in the emergency department (ED) prior to being hospitalized, and the amount of time that the ED psychiatrists spent obtaining authorization from the patient’s insurer. A group of 11 psychiatric residents working in the psychiatric ED with acutely ill psychiatric patients collected the data.

Most patients required hospitalization because they were suicidal or, in a few cases, homicidal.

Although obtaining insurance authorization delayed care and took clinicians away from other duties, only one of the 53 requests for authorization was denied. Median total time in the ED was 8.5 hours, with the shortest stay lasting 3 hours and the longest stay lasting 20 hours.

These numbers do not include a handful of patients who boarded in the ED over the weekend while waiting for an inpatient bed to become available for them. The numbers also exclude uninsured patients and those with Medicare, which does not require prior authorization.

The authors concluded that, with approximately 1.6 million psychiatric admissions among people with private insurance nationwide each year, 38 minutes of phone time to obtain authorization translates into about 1 million hours of wasted psychiatrist time.

“Society pays for inadequate psychiatric care; more than half of all prison inmates and a third of all homeless people are mentally ill,” said lead author Dr. Amy Funkenstein. “Massachusetts is considered a model for health reform, and yet we found that seriously ill patients routinely spent hours stranded in the ED due to insurance bureaucracy. The hours psychiatrists spend obtaining those authorizations could be far better spent treating our patients.”

Source: Physicians for a National Health Program; April 23, 2013.

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