ABSTRACT
Prior authorization (PA) introduces significant administrative complexities in radiation oncology, yet its impact on medical dosimetrists remains unexamined. This cross-sectional mixed-methods study evaluates the operational and economic implications of PA through a national survey assessing time allocated to PA-activities, job satisfaction, and workflow disruptions among certified medical dosimetrists (CMDs), combined with a time-driven activity-based costing (TDABC) analysis to estimate associated costs. A total of 714 responses (15.1% response rate) were analyzed. Findings indicate that medical dosimetrists spend a median of 60 minutes per week on each of the identified PA-activities. Half (50.0%, n = 357) of respondents reported treatment delays of one to three days due to PA. Multivariable regression analysis showed that increased involvement in PA-related replanning was significantly associated with job dissatisfaction (OR = 1.225, 95% CI: 1.09 to 1.38, p < 0.001) and perceived declines in treatment plan quality (OR = 1.35, 95% CI: 1.209 to 1.521, p < 0.001). The TDABC model estimated an annual financial burden of $12.68 to $38.05 million based on the time contributions of medical dosimetrists to PA-related activities, contributing to a total industry-wide PA cost exceeding $78 million in radiation oncology. These findings demonstrate that medical dosimetrists contribute a significant amount of resources toward PA activities, resulting in additional costs that were not considered by previous economic models measuring the cost of PA in the radiation oncology industry. 7 PA requirements were associated with clinical workflow interruptions and professional challenges, as reflected in treatment delays and job dissatisfaction reported by dosimetrists. These findings provide new insights into PA-related demands in radiation oncology and emphasize the need to account for dosimetrists’ contributions in future evaluations.
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