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Improving the Efficiency of Pediatric Spinal Fusion Precertification
Lynessa McGee1, Jen Anadio1, Taryn McCarthy-Isfort1
1Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Journal of the Pediatric Orthopaedic Society of North America
|February 2, 2026
Summary
Implementing a standardized preoperative template and scheduling visits at least 4 weeks prior to surgery significantly reduced precertification denials for pediatric spinal fusions. This quality improvement initiative decreased denial rates from 15.4% to 2.9%, easing administrative burdens.
Area of Science:
- Quality Improvement in Healthcare
- Health Services Research
- Surgical Operations Management
Background:
- Precertification processes by insurers aim to curb unnecessary spending but can lead to significant administrative burdens.
- Pediatric spine centers experienced increased denials and peer-to-peer interactions for precertification in 2022.
- A quality improvement project was initiated to mitigate the time and resource demands associated with precertification appeals.
Purpose of the Study:
- To reduce the administrative burden of precertification denials and peer-to-peer interactions in a pediatric spine center.
- To identify and address the primary causes of spinal fusion denials.
- To improve the efficiency of the precertification process for pediatric spine surgeries.
Main Methods:
- A Pareto analysis was conducted to determine the leading causes of spinal fusion denials.
- Interventions were developed using a key driver diagram and implemented through plan-do-study-act cycles.
- Key interventions included a standardized preoperative template and shifting the preoperative visit to at least 4 weeks prior to the procedure.
Main Results:
- Pareto analysis identified "supporting documentation" and "not medically necessary" as the top reasons for denials.
- Implementation of the preoperative template (March 2023) and adjusted visit timing (May 2023) led to a significant reduction in denials.
- The median monthly denial rate decreased from 15.4% before May 2023 to 2.9% after implementation.
Conclusions:
- Quality improvement methods, specifically a standardized template and earlier preoperative visits, effectively reduced precertification denials for pediatric spinal fusions.
- Addressing key denial reasons streamlined the precertification process, decreasing the need for surgeon peer-to-peer interactions.
- These efficiency improvements can help alleviate administrative obligations and potentially reduce physician burnout.
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