Impact of a centralized APP-led peer-to-peer program on patient access, provider burden, and institutional revenue.

Abstract

1549 Background: Prior authorization (PA) and peer-to-peer (P2P) requirements impose a significant administrative burden on oncology clinicians, contributing to burnout and care delays. At our Comprehensive Cancer Center, internal data showed frontline Advanced Practice Providers (APPs) and oncologists spent unsustainable hours on insurance denials. To mitigate clinical fatigue and optimize workflows, we launched a centralized initiative transitioning P2P responsibilities from frontline clinicians to a specialized APP team. Methods: Following a successful pilot project, a centralized P2P program was established for outpatient diagnostic imaging denials. Based on early success, the program expanded to include outpatient medication-related denials. A dedicated APP team utilized standardized workflows, documentation, and formal escalation pathways to manage all outpatient P2P referrals. Program performance was evaluated on these metrics: 1) Access to Care: Measured by completion rate, authorization turnaround time (TAT) and pre-authorized status at arrival. 2) Provider Burden: Assessed by administrative hours reclaimed from frontline staff and qualitatively via a provider satisfaction survey. 3) Institutional ROI: Evaluated via denial overturn rates and net reclaimed revenue from authorized billable services. Results: Centralization markedly improved operational efficiency. The program achieved a clear increase in P2P completion rate from 80% provider-led baseline to 99% by centralized team. This coupled with a reduction in TAT for both imaging and medication authorizations, increased the percentage of patients arriving with pre-authorized status by 12% in the first two years. Overturn rates and positive disposition for initial denials rose to 85% or greater compared to the provider-led baseline of 78%. Frontline clinicians reported a substantial decrease in daily administrative tasks, facilitating increased patient-facing hours and improved work-life integration. Financially, the program demonstrated a robust ROI by securing authorization for high-cost services previously denied and providing payer trend data to inform broader managed care strategies. Conclusions: Centralizing P2P responsibilities within a dedicated APP team is a multidimensional solution that extends beyond revenue recovery. This model effectively mitigates provider burnout, optimizes patient flow, and protects clinical capacity. As oncology practices face increasing complexity in 2026, this scalable model offers a vital roadmap for balancing financial health with workforce sustainability.