ABSTRACT
In the event of prior authorization denial, physicians may request peer-to-peer review, which may delay treatment and increase administrative burden. The purpose of this study was to quantify the approval rate of peer-to-peer review and evaluate its efficiency in the context of advanced imaging use in an orthopedic practice. Patients at a single outpatient orthopedic clinic initially receiving an insurance denial for computed tomography or magnetic resonance imaging requiring peer-to-peer review from March to December 2022 were prospectively enrolled. Characteristics of the request, peer-to-peer review, and the reviewer and dates in the process were collected. If the study was approved after peer-to-peer review, the date of the imaging study and brief results were recorded. A total of 62 denials were included. One denial was approved prior to peer-to-peer review. Fifty-eight (of 61, 95.1%) reviews were approved, of which 51 (of 58, 87.9%) studies were completed by patients. Reviewers were always physicians (61 of 61, 100%), but of those whose specialty was known, none were orthopedic surgeons. Forty-four of 61 (72.1%) reviewers reported reviewing clinical notes in advance. The median number of days from visit to peer-to-peer review was 9.0 (interquartile range, 7.0-13.25). The median number of days from visit to imaging center appointment was 13.5 (interquartile range, 9.0-20.75) for approved studies. Of the 51 approved studies completed by patients, the results of 38 (74.5%) confirmed the suspected diagnosis. In an orthopedic specialty practice, almost all peer-to-peer reviews were approved, with the majority of the completed studies confirming the suspected diagnosis. Thus, patient care was delayed. Reform is crucial to improve the efficiency of the review process, especially in light of additional administrative and financial burden. [Orthopedics. 202x;4x(x):xx-xx.].
ABSTRACT
BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) society has advanced the practice of shoulder and elbow care through the exhibition of research at academic meetings. The ASES annual meeting is a closed (member-only) conference annually held in October, while the specialty day is an open (non-members included) event that takes place during the American Academy of Orthopaedic Surgeons (AAOS) meeting week in March. This study aims to compare the rate of publication for abstracts presented at the open and closed ASES meetings from 2013 to 2019. METHODS: The ASES website was searched to obtain the annual meeting and specialty day program agendas from 2013 to 2019. A standardized search protocol was employed to identify conference abstracts that went on to be published. Publications associated with an ASES abstract were analyzed through several variables including the time to publication, journal impact factor (JIF), and level of evidence. RESULTS: There was no difference between the rates of publication of the open (76.5%, 121/158) and closed (75.3%, 223/296) meetings (P = .904). The median time to publication significantly differed between the open (7 months, 95% confidence interval [CI]: 5.0-10.0) and closed (11 months, 95% CI: 9.0-13.0) meetings (P = .02). There was no difference between the median JIF between the open (2.69, 95% CI: 2.41-2.81) and closed (2.73, 95% CI: 2.41-2.81) meetings. The distribution of the level of evidence in published articles comparing the open and closed meetings did not differ significantly (P = .446). DISCUSSION: The overall quality of academic research presented at orthopedic subspecialty conferences can be objectively evaluated through abstract publication rates. Our analysis demonstrates that there is not a single significant difference among the publication rates, median JIF, and level of evidence distribution between the ASES open and closed meetings from 2013 to 2019. Impactful research is showcased at both the open and closed meetings. Societies that limit submissions from members only at annual meetings can consider soliciting research from non-members. While the quality of research would not decline if non-ASES members were invited to participate, the presence of a closed annual meeting may be a valuable tool for societies to expand their reach through member-exclusive benefits.
