Pre-authorization processes have no effect on patients undergoing knee MRI in a pediatric setting when evaluated by specialists

• Published in: Skeletal radiology 2017-02, Vol.46 (2), p.171-175
• Main Authors: Pierce, Drew, Kan, J. Herman, May, Megan, Bisset, George S.
• Format: Article
• Language: English
• Subjects: Adolescent; Care and treatment; Child; Comparative analysis; Decision Making; Female; Health insurance industry; Humans; Imaging; Insurance Carriers; Insurance, Health; Knee Injuries - diagnostic imaging; Knee Injuries - surgery; Knee Joint - diagnostic imaging; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Nuclear Medicine; Orthopedics; Pathology; Patients; Pediatrics; Radiology; Referral and Consultation; Retrospective Studies; Scientific Article; Young Adult
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-016-2509-1

Objective Pre-authorization processes are often used by medical insurance companies to reduce costs by managing the utilization of advanced diagnostic imaging, and their impact on patient care is unclear. The purpose of our study is to determine if a pre-authorization process increases the rate of surgically significant abnormal knee MRI and surgical referrals compared with patients referred from pediatric orthopedic specialists who do not undergo a pre-authorization process. Materials and methods A retrospective study was performed; 124 patients were identified who were referred for knee MRI by a pediatric orthopedist. The study population included patients who underwent an insurance pre-authorization process and the control group consisted of those who did not. The results of the MRI and whether they were deemed surgically significant, in addition to surgical referral, were recorded and compared. Results The study and control groups showed no statistically significant difference in outcome with regard to surgically significant findings on MRI ( p  = 0.92) or whether the patient required surgery ( p  = 0.6). Conclusions In this population, there is no difference in the likelihood of an abnormal knee MRI demonstrating surgically significant findings or referral to surgery in patients who did and those who did not undergo an insurance pre-authorization process when patients are referred from a pediatric orthopedic specialist. The insurance pre-authorization process does not appear to have an impact on patient diagnosis and treatment and may unnecessarily add bureaucracy and costs.