The Impact of Commercial Health Plan Prior Authorization Programs on the Utilization of Services for Low Back Pain

i) Observational Study
ii) Lumbar fusions decreased from 76.27/100,000 to 62.63/100,000 in the first year of Prior Authorization (PA) programs, but increases to 64.24/100,000 and 73.84/100,000 the two following years.
iii) Per-member, pre-surgical costs increased by $2,233 with the physiatrist PA and an additional $1,370 with implementation of the LBP surgery PA.
iv) Mandatory referral to a physiatrist before surgical evaluation did not result in persistent reduction in lumbar fusions. PA programs were associated with increased costs from more nonoperative care for only a transitory change in the lumbar fusion rate

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