Latest advances in the use case and the success of Mayo Clinic’s adoption of minimal Common Oncology Data Elements (mCODE) to improve routine oncology clinical care focus of June Community of Practice
Prior authorization continues to be a pain point across the health care spectrum, and this month’s CodeX Community of Practice meeting will be highlighting prior authorization and how a standards-based approach is improving care at the Mayo Clinic.
According to a 2022 American Medical Association survey, 94% of physicians reported care delays associated with prior authorization, and 80% said these requirements can at least sometimes lead to patients abandoning treatment.
When treating cancer, the delays could be deadly.
Within CodeX, the Prior Authorization in Oncologyuse case focused on prostate cancer treatment is making strides in its iteratively phased proof-of-concept (POC). A goal of the use case is to automate prior authorization for cancer treatment so that 80% of approvals do not require manual inspection, expediting care for patients and reducing physician burden. CodeX participants are proving the utility of the Implementation Guides Coverage Requirements Discovery (CRD), Documents Template Requirements (DTR) and Prior Authorization Support (PAS) as developed by the HL7 Da Vinci Project Burden Reduction use case as well as in the Centers for Medicare and Medicaid Services December 2022 proposed rule Advancing Interoperability and Improving Prior Authorization Processes.