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Saturday, November 11, 2023

Wait Times for Diagnosis

In The Politics of Autism, I discuss evaluationdiagnosis, and waitlists

 A release from Cognoa:

Cognoa, a leading child development and behavioral health company, today published a new report, The State of Pediatric Autism Diagnosis in the U.S.: Gridlocks, Inequities and Missed Opportunities Persist, that underscores the longstanding waitlist crisis for children and their families seeking a diagnosis of developmental delays and autism evaluation. The report assesses results from 111 specialty centers across the U.S.

On average, children and their families are forced to wait three years from the time of first concern of developmental delay to an autism assessment. Delays in diagnosis mean that children are missing the opportunity for early intervention during the critical early neurodevelopmental period when interventions have the greatest life changing impact.

Excessively long waitlists to see the small number of available specialists and the absence of a "standard of care" are major causes for concern throughout the healthcare community. The study, which was conducted by Scott Badesch, Former President of the Autism Society of America, and sponsored by Cognoa, uncovers widespread reimbursement issues that prevent families, especially the already disadvantaged, from receiving an evaluation and subsequent early interventions altogether.

Key findings reveal the inequities and inefficiencies in status quo processes that are leaving most children and families behind:

Unacceptably Long Wait Times for Evaluation
  • Nearly two thirds of specialty care centers surveyed report wait times of over 4 months between an initial request for an autism evaluation to the time a diagnostic evaluation is conducted.
  • Of that group, 21% report waitlists of more than a year or that are so impacted that they are no longer accepting new referrals.

Reimbursement Barriers Reinforce Healthcare Inequality
  • 44% of centers surveyed do not accept Medicaid, pointing to access disparities which affect already underserved communities most.
  • Only 65% of practices accept commercial insurance, forcing those who cannot pay initial costs up front to forego care.
  • 77% of clinics identified the extreme length of assessment processes and heavy documentation burdens among the top barriers to timely evaluation.
  • 69% of clinics identified staffing issues, including clinician and administrator shortages.
  • 43% cited burdensome reimbursement processes and inadequate or lack of reimbursement as barriers to timely care.

No Standard of Care
  • The data shows high variability in the assessment tools used in today's diagnostic processes, of which there are over 30 listed.
  • There are vast state-to-state and healthcare payer-to-payer differences in requirements of both assessment and provider type for an autism diagnosis to be recognized for reimbursement.
  • 83% of centers report that autism evaluations take over 3 hours. Of these, 25% report evaluation completion times of over 8 hours. Research shows that these lengthy assessments are not necessary for most children.

The full report can be found here.