1017 - Relationship between Payer Organizational Stability and Radiation Oncology Treatment Timelines: A Time-Series Analysis
Presenter(s)
W. C. Chen1,2, C. Carpenter3, J. Hwang1, A. Pattison3, B. U. Sidiqi1,4, M. B. Nash3, D. Pappas3, and L. Potters1,5; 1Northwell, New Hyde Park, NY, 2Department of Radiation Medicine, South Shore University Hospital, Bay Shore, NY, 3TurningPoint Healthcare, Lake Mary, FL, 4Department of Radiation Medicine, Northwell, New Hyde Park, NY, 5Department of Radiation Medicine, Lenox Hill Hospital, New York, NY
Purpose/Objective(s):
Prior authorization (PA) is a well-known burden that can delay timely cancer care. While performance variation in PA is anecdotally recognized, the longitudinal variability of this process has not been well characterized, especially how acute corporate instability impacts timely cancer care. This study quantifies prescription-to-treatment (Rx-to-Tx) variability across major third-party administrators (TPAs), and analyzes the effect of organizational turmoil and realignment at a large national TPA.
Materials/Methods:
We performed a retrospective analysis of consecutive radiation oncology cases at a large health system from Dec 2023 to Jan 2026 requiring PA managed by four large TPAs (TPA-A, TPA-B, TPA-C, and TPA-D). Cases not managed by these TPAs, such as traditional Medicare, were excluded. The primary endpoint was monthly median Rx-to-Tx time. Rx-to-Tx time was defined as days from prescription signature to first treatment fraction. Process volatility was assessed using the standard deviation (SD) of monthly medians. Kruskal-Wallis and Levene’s tests compared Rx-to-Tx distributions and variance. An interrupted time-series analysis (ITSA) modeled data for TPA-D, using a Dec 2024 leadership crisis as a sentinel event.
Results:
A total of 6,827 cases were analyzed (TPA-A: 2,540; TPA-B: 1,943; TPA-C: 1,290; TPA-D: 1,054). Significant differences in median Rx-to-Tx times (Kruskal-Wallis, p<0.001) and process variability (Levene’s test, p<0.01) were observed across TPAs. TPA-D was the most volatile (overall median: 7.5 days; SD of medians: 2.2 days). In contrast, TPA-A (median: 6.0d, SD: 0.8d) and TPA-B (median: 6.0d, SD: 1.0d) were highly stable, while TPA-C (median: 6.0d, SD: 1.8d) showed moderate volatility.
TPA-D’s performance was highly volatile even during the pre-crisis period (Dec 2023 - Nov 2024, median: 8.7d, SD: 2.3d). ITSA showed the Dec 2024 crisis was associated with significant volatility as median Rx-to-Tx peaked at 12.0d then dropped to 3.0d in Jan 2025 (p<0.001), before rebounding to 8.0d. The subsequent corporate realignment period due to market turmoil (May 2025 - Jan 2026) showed persistent volatility (SD 1.4d) with no significant variance reduction from baseline (p=0.296).
Conclusion:
Operational stability is a critical factor associated with timely access to care. An acute corporate crisis at one TPA was temporally associated with a dramatic fluctuation in PA timelines. However, subsequent planned leadership changes failed to produce a consistent, stable PA process within the observed timeframe. Internal payer dynamics and market turmoil are an unpredictable variable affecting patient care, and high-level corporate restructuring may not rapidly correct ground-level workflow inefficiencies.