Administrative Tasks Lead To Skipped Appointments and Unfulfilled Prescriptions in Cancer Care

Administrative Tasks Lead To Skipped Appointments and Unfulfilled Prescriptions in Cancer Care

Patients who are required to engage in administrative tasks are more likely to skip a doctor’s appointment, forego tests and bloodwork, and leave their prescriptions unfulfilled, according to findings published in Cancer Epidemiology, Biomarkers, & Prevention.

The study demonstrated that patients who were required to complete administrative tasks were 18% more likely to delay or forego care (95% CI, 0.12-0.24). For every unit increase in administrative payment burden, patients were 32% more likely to delay or forego care (95% CI, 0.18-0.46).

Compared with patients older than 55, patients who are younger than 44 were found to be most likely to face administrative tasks and deal with cost-related delays and nonadherence as a result. African American patients were more likely than White patients to face administrative tasks and subsequent delays.

“Individuals and families that lack the various forms of capital needed to effectively engage with the healthcare system—as well as those who have been historically, and often purposefully, excluded from accessing the forms of capital—are at a disadvantage,” study authors wrote. “At its most extreme, excessive administrative burdens exclude some individuals from health benefits entirely.”

Both providers and patients have described the current health care delivery and financing system to be excessively complex, and health insurance and medical billing processes are time-consuming and expensive for both of these parties.

When patients receive a cancer diagnosis, they are faced with a host of care needs to navigate. Along with their caregivers, they must make decisions regarding treatment, learn to manage adverse events—often including cognitive impairments—and schedule a number of appointments. Patients and their caregivers must also determine the extent to which their insurance company will cover healthcare costs and make a plan to cover the costs for which they are responsible.

In addition, patients may need to address certain administrative tasks related to their health. These tasks can include complying with requirements related to insurance eligibility verification, handling complex billing services and payment policies, obtaining prior authorizations for insurance company representatives, and appealing payment denials. As the study authors note, handling these tasks can be burdensome for any individual, let alone a patient facing the effects of anticancer therapies. Therefore, they sought to understand the administrative burden that patients face and how it impacts their access to care.

Investigators analyzed survey data from 510 patients and survivors. A two-part model was deployed to assess the relationship between administrated burden and treatment delays. Most of the individuals who responded were women (65%), 55 years or older (58%), and non-Hispanic White (71%).

In terms of health insurance, 55% had either Medicare, Medicaid, or both, and 37% were covered by an employee-sponsored commercial insurance. Among the remaining, 2.7% had Tricare/Champus Veteran’s Insurance, and 5.2% had other insurance.

The study authors concluded by noting that streamlining the healthcare delivery system should be an urgent action item for all stakeholders.

“For those who do engage, there’s frustration, exhaustion, and I think a sense of alienation. If you send me a bill erroneously and can’t help me correct it, you’re showing me you don’t care about me,” Meredith Doherty, PhD, LCSW, an assistant professor at the University of Pennsylvania School of Social Policy & Practice, stated in a press release. “We are at a place now where we may want to quantify how much improvement in outcomes we might see if we alleviated some of these administrative burdens.”

References

1. Doherty M, Thom B, Gardner DS. Administrative burden associated with cost-related delays in care in US cancer patients. Cancer Epidemiol Biomarkers Prev. 2023;OF1-OF8. doi:10.1158/1055-9965.EPI-23-0119
2. American Association for Cancer Research. Engaging in Administrative Payment Tasks May Correlate With Treatment Delays and Nonadherence in Cancer Care. News release. August 30, 2023. Accessed August 28, 2023. https://www.aacr.org/about-the-aacr/newsroom/news-releases/engaging-in-administrative-payment-tasks-