“devised to help lower health care spending [MA] has instead become substantially more costly than the traditional government program it was meant to improve.” nytimes.com/2022/10/08/ups…
2/ “Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but @CMSGov has never chosen to do so.”
“Hospitals and doctors strongly believe that no patient should fear receiving a surprise medical bill and that patients should be kept out of the middle of any billing disputes between providers and commercial health insurance companies.”
continued 👇
3/“The AHA & AMA fully support the lawsuit just filed in the United States District Court for the Eastern District of Texas which challenges the government’s August 2022 final rule (tinyurl.com/ycypc2fa) regarding the No Surprises Act’s independent dispute resolution process.”
🧵👏👏 TY @RepBera @RepLarryBucshon for introducing HR 8800, the “Supporting Medicare Providers Act of 2022.”
This would give critical support to physicians who, w/release of the proposed rule for the 2023 Medicare Physician Fee Schedule, again face payment cuts.
2/ Read: Across-the-board Medicare physician pay cuts are wrong way forward
3/ The bipartisan legislation would provide relief from the scheduled 4.42% Medicare conversion factor payment cut and offer stability as the @AmerMedicalAssn works to improve the #Medicare payment system.
“…PBMs make up an oligopoly of rich, vertically integrated conglomerates that routinely prey on health care practices, providers, and their patients.”
2/ “PBMs have done this by overwhelmingly abusing their responsibility to protect Americans from this country’s drug pricing crisis, instead exploiting the opacity throughout the nation’s drug supply chain to enrich themselves.”
3/ “[The report] explores how the recent levels of consolidation among PBMs and health insurers is adversely impacting #cancer care, fueling drug costs, all while allowing for massive profits for #PBMs and health insurance companies.”
🧵⬆️ evidence that insurer-imposed authorizations for drugs & medical services can be a hazardous & burdensome administrative obstacle to patient-centered care.
Yet “…health insurer industry continues to show apathetic or ineffectual follow-through on mutually accepted reforms”
2/ “Prior authorization requirements should be selectively applied to physicians based on demonstrated adherence to evidence-based guidelines and quality measures, according to the consensus statement.” But happens in only 9%.
3/ The list of drugs and services that require prior auth should be regularly reviewed by insurers to remove items that show "low variation in utilization or low prior authorization denial rates," per consensus statement.
But, high & ⬆️ drugs, med services requiring prior auth.
An investigation by @OIGatHHS “into the inappropriate use of #PriorAuthorization by Medicare Advantage plans uncovered information that mirrors physician experiences.”
2/ “Surveys of physicians have consistently found that excessive authorization controls required by health insurers are persistently responsible for serious harm when necessary medical care is delayed, denied, or disrupted.” #FixPriorAuth
3/ “The American Medical Association agrees with the federal investigators’ recommendations for preventing inappropriate use of authorization controls to delay, deny and disrupt patient care, but more needs to be done to reform prior authorization.”