The Impact of Commercial Health Plan Prior Authorization Programs on the Utilization of Services for Low Back Pain.

ABSTRACT:

Study design

An observational study.

Objective

The aim of this study was to evaluate the impact of a health plan's prior authorization (PA) programs for low back pain (LBP) in a non-Medicare population by assessing changes in pre-surgical nonoperative care; lumbar fusion trends; and overall back surgery rates compared with another health plan with a similar program and national benchmarks. The PA programs require mandatory physiatrist consultation before surgical evaluation, with subsequent additional LBP surgery PA.

Summary of background data

LBP is prevalent and concern exists that spinal fusion is overutilized for LBP.

Methods

Annual rates of lumbar fusion trended over 6 years, and analysis of changes in standardized costs for LBP-related services among a 50

SUBMITTER: Goodman RM 

PROVIDER: S-EPMC4834807 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature