Evidence map›Paper›PMID 37750969›Full record

ArticlePediatric cardiology2024

Burden with No Benefit: Prior Authorization in Congenital Cardiology.

Brian S Marcus, Neha Bansal, Joshua Saef, Christina Fink, Angira Patel, Katherine D Shaffer, John E Mayer, Jonathan N Johnson, Kenneth Shaffer, Devyani Chowdhury

Abstract read
In one paragraph

Article in Pediatric cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Article
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  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Brian S MarcusPediatric Cardiology, Yale School of Medicine, 205 Church Street, New Haven, CT, USA. brianmarcusmd@gmail.com.ORCID http://orcid.org/0000-0001-5775-4143
Neha BansalPediatric Cardiology, Mount Sinai Kravis Children's Hospital, New York, NY, USA.
Joshua SaefPhiladelphia Adult Congenital Heart Center, University of Pennsylvania, Philadelphia, PA, USA.
Christina FinkChildrens Institute Department of Heart, Vascular & Thoracic, Division of Cardiology & Cardiovascular Medicine, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
Angira PatelAnn & Robert H. Lurie Childrens Hospital, Chicago, IL, USA.
Katherine D ShafferTexas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Abilene, TX, USA.
John E MayerDepartment of Cardiac Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
Jonathan N JohnsonDivision of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
Kenneth Shaffer *Dell Medical School, University of Texas, Austin, TX, USA.
Devyani Chowdhury *Nemours Cardiac Center, Wilmington, DE, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Prior authorization is a process that health insurance companies use to determine if a patient's health insurance will cover certain medical treatments, procedures, or medications. Prior authorization requests are common in adult congenital and pediatric cardiology (ACPC) due to need for advanced diagnostics, complex procedures, disease-specific medications, and the heterogeneity of the ACPC population. Prior authorizations in ACPC are rarely denied, but nonetheless, they are often accompanied by significant administrative burden on clinical care teams and delays in patient care. Prior authorizations have been implicated in worsening care inequities. The prior authorization process is insurer specific with differences between commercial and public insurers. Prior authorization rejections were previously found to be more common for women, racial minorities, those with low education, and in low-income groups. Prior authorization unduly burdens routine diagnostics, routine interventional and surgical procedures, and routine cardiac specific medication use in the ACPC population. This manuscript highlights the burdens of prior authorization and advocates for the elimination of prior authorization for ACPC patients.

Indexed as

CardiologyPrior AuthorizationAdultChildFemaleHumansCongenital heart diseasePediatric cardiologyPrior authorizationReform

Identifiers

PMID37750969
PMCPMC10776488

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.