Marilyn Heine Profile picture
Feb 25 6 tweets 3 min read Read on X
🔥 From AMA:

“Many physicians fear the #healthinsurance industry’s use of unregulated #artificialintelligence (#AI) automation and predictive technologies will increasingly override good medical judgment and systematically deny #patients coverage for necessary #medicalcare. “🧵 Image
2/ “According to a new survey from @AmerMedicalAssn, 3️⃣ in 5️⃣ physicians (61%) are concerned that health plans’ use of AI is increasing prior auth denials, exacerbating avoidable patient harms and escalating unnecessary waste now and into the future.”

👉 tinyurl.com/mt2h7dedImage
@AmerMedicalAssn 3/ “Burdensome #priorauthorization requirements that conflict with evidence-based clinical practices & create hurdles to patient access to safe, timely, & affordable treatment have been a major impediment to patient care for decades.”

Read @PresAmerMed statement⤵️

#FixPriorAuth Image
@AmerMedicalAssn @PresAmerMed 4/❗️“More recently, health insurers have turned to AI decision-making tools that generate prior auth decisions w/ little or no human review. These AI tools have been accused of producing high rates of care denial—in some cases, 16X higher than is typical.”
tinyurl.com/mrxzswuvImage
@AmerMedicalAssn @PresAmerMed 5/ “…AMA firmly believes that AI must augment decision-making; be referred to as ‘augmented intelligence,’ and not remove humans from patient care, coverage, or treatment.”

“…AMA policy identifies significant concerns with insurer use of AI.”

tinyurl.com/3sw4yz5jImage
@AmerMedicalAssn @PresAmerMed 6/ “Notably, the AMA’s Augmented Intelligence Research released earlier this month found that nearly half of all physicians (49%) ranked oversight of payers’ use of AI in medical necessity determinations among the top 3 priorities for regulatory action.”

tinyurl.com/3se9epm5Image

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More from @MarilynHeineMD

Dec 18, 2024
Author describes 2 caps that patients face in Medicare Advantage (MA).

But wait, there’s more.

This 🧵 includes messages from the author (🚩) on how the “caps” are not all-encompassing limits.

And related points (🤔) to ponder & prompt pause.



Read ⤵️ tinyurl.com/3vhyup4vImage
2/ 🚩 “Medicare Advantage plans may have low premiums but they are pay-as-you-go, copayments or coinsurance for medical services.”

🤔 if a hospital buys a physician practice, patients will likely have increased out-of-pocket costs.
3/ 🤔 When a hospital acquires a previously independent physician practice, why does a patient pay more for the care?

•Facility fees

•Potentially ⬆️ copayments and coinsurance: This can vary depending on the specific insurance plan and terms of the contracts with insurers.
Read 10 tweets
Jul 30, 2024
🧵2 health IT updates

1️⃣@ONC_HealthIT⁩ ⁦@CMSGov⁩ released a Final Rule implementing disincentives for physicians & other health care providers in specific Medicare programs that ⁦@HHSGov⁩ has determined have committed information blocking.

tinyurl.com/38bkedve
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2/ The @AmerMedicalAssn created a summary brief about the new final regulation.

🗓️It is important to note that physicians and other health care providers will be subject to ONC and CMS’ disincentive regulations starting July 31, 2024. 

tinyurl.com/54csnv68



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@AmerMedicalAssn 3/ ONC has defined "#informationblocking" as any practice that is likely to interfere with the access, exchange or use of electronic health information (EHI), unless covered by an exception.

tinyurl.com/pvd76xr5
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Read 12 tweets
Jun 21, 2024
🚨🧵AMA survey indicates prior authorization (PA) wreaks havoc on patient care

Access to patient-centered care continues to suffer as health insurers

❗️Impose PA barriers on necessary care

❗️Substitute corporate policy for clinical decisions that are in patients’ best interest Image
2/🔥AMA survey shows that turmoil caused by excessive authorization controls leads to:

❗️Serious or life-threatening events for patients

❗️Unnecessary waste

❗️Physician burnout

Read:

Survey: 👇Includes health plan performance! tinyurl.com/yck5d5hs
tinyurl.com/wjrxwuzw



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3/ “Prior authorization is a blunt cost-control tactic requiring physicians to obtain approval from a health insurance company before a treatment qualifies for coverage.”
Read 18 tweets
May 21, 2024
🎇🧵Over 100 medical organizations want clarity in ⁦@Change_HC⁩ #cyberattack

⁦@AmerMedicalAssn⁩ & others want ⁦@HHSGov⁩ to affirm that ⁦@UnitedHealthGrp⁩ alone bears responsibility for notifying patients of potentially stolen #PHI. healthcarefinancenews.com/news/over-100-…
2/ “We are writing to request more clarity around reporting responsibilities and assure affected providers that reporting and notification obligations will be handled by Change Healthcare.”


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3/ “@HHSOCR should publicly state that its breach investigation and immediate efforts at remediation will be focused on Change Healthcare, and not the providers affected by Change Healthcare’s breach.”
Read 4 tweets
Apr 23, 2024
🚨🧵UnitedHealth Group (UHG) issued a press release 4/22 with more info about the Change Healthcare #Cyberattack and the impact of the breach on personal data.

UHG officials have agreed to address any additional questions from the ⁦@AmerMedicalAssn⁩ or the Federation. Image
2/ Please read the UHG press release here:

Send any questions you may have to ama.advocacy@ama-assn.org. AMA will try to get answers from UHG. tinyurl.com/2mcj4uh5
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3/ UHG’s press release states its preliminary findings from ongoing investigation & review of data involved in the cyberattack are:

a. Based on sampling of their data, files containing protected health info (PHI) or personally identifiable info (PII) were involved in the breach.
Read 12 tweets
Mar 27, 2024
🚨🧵@AmerMedicalAssn 3/26 Update on Change Healthcare cyber outage

❗️Important Survey: How has the cyber outage affected your practice? Help inform AMA advocacy for you. Deadline 3/29 tinyurl.com/9bjca2ft
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2/ On March 25, the Department of Health and Human Services (HHS) distributed these resources to assist physicians, pharmacists and hospitals, with the aftermath of the Change Healthcare #cybersecurity attacks.

👉 tinyurl.com/4pjvmpyz
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3/ AMA told HHS multiple times that physicians were having difficulty securing info from health insurers about:

-availability of assistance w/payments
-flexibilities from admin requirements
-additional contact info for troubleshooting d/t Change Healthcare cybersecurity attack
Read 8 tweets

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