“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.”
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
“…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.”
May 25 • 9 tweets • 4 min read
🧵⬆️ 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%.
An investigation by @OIGatHHS “into the inappropriate use of #PriorAuthorization by Medicare Advantage plans uncovered information that mirrors physician experiences.”
Read report: oig.hhs.gov/oei/reports/OE…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
“These automatic cuts should remind members of the needed reforms. Congress can get a head start on doing the right thing when it reconvenes early next year.”
AMA statement: tinyurl.com/2wtbarfc2/ Last evening, the Senate passed legislation to halt Medicare physician payment cuts that were scheduled to take effect on January 1. President Biden is expected to sign the bill into law.
Highlights of the physician payment provisions include the following: 👇
Dec 9, 2021 • 16 tweets • 6 min read
🧵@AmerMedicalAssn @ahahospitals representing physicians, hospitals, and health systems sued the federal government today over the misguided implementation of the federal surprise billing law, No Surprises Act. The final rules jeopardize access to patient care. 2/ The associations are joined in the suit by plaintiffs including Renown Health, UMass Memorial Health and 2 physicians based in North Carolina.
🎇Warrants urgent action by Congress to stop Medicare cuts 2/ Despite a mid-year rebound after sharp declines early in the year, Medicare spending on physician services during 2020 NEVER RECOVERED to its pre-pandemic trend.
Struggling physician practices face a difficult and precarious road to recovery.
#maternalhealth2/ If passed, the bill would create a task force on maternal #mentalhealth which would identify, evaluate, make recommendations to coordinate & improve federal responses to maternal mental health conditions, create a national strategic plan for addressing mental health disorders.
Oct 23, 2021 • 12 tweets • 8 min read
🧵A bipartisan pair of congressional physicians @RepBera @RepLarryBucshon is leading a major effort urging House leadership @GOPLeader @SpeakerPelosi
to avert impending #Medicare payment cuts that add up to a reduction of nearly 10% effective Jan. 1. 2/ More than 245 other representatives from both parties in a letter asking House leadership to provide financial sustainability for physicians and help maintain access to care.
👉 • HHS is also announcing today a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period.
🧵UHC modifies laboratory designated diagnostic provider (DDP) program
AMA, many state medical associations, & national medical specialty societies expressed strong concerns about the DDP’s impact on physician practices & patients. In response to this advocacy, UHC made changes. 2/ Earlier this year, United Healthcare (UHC) announced the launch of its Designated Diagnostic Provider (DDP) program for laboratory services. To qualify as a DDP, a laboratory must meet certain quality and efficiency (i.e., cost) requirements.
•Do not divert scarce health-related offsets to meet objectives unrelated to healthcare.
Physicians already face steep Medicare fiscal challenges.
2/ AMA expresses “deepening alarm concerning the growing financial instability of the Medicare physician payment system.”
“Not only does Congress seem indifferent to the confluence of fiscal uncertainties confronting physician practices at the end of this year, but…”
Jul 20, 2021 • 12 tweets • 5 min read
🧵#OurAMA issues initial summary of “Interim Final Rule (Part 1) Implementing Certain Provisions of the #NoSurprisesAct.”
Several initial concerns:
•Way the QPA (median contracted rate) will be determined
•Provisions that ⬆️ admin burden for physicians without patient benefit 2/ July 1 @HHSGov@USDOL@USTreasury (Tri-Agencies), @USOPM released an IFR with comment period tinyurl.com/smenwxk4 implementing many provisions of the #NoSurprisesAct signed into law as part of the Consolidated Appropriations Act, 2021 COVID-19 relief bill.
At the height of the #COVID19#pandemic, physicians reported being bedeviled by unnecessary, bureaucratic obstacles that the health insurance industry pledged to reduce three years ago. 2/ The data highlights the urgent need for new bipartisan legislation introduced in the House, the Improving Seniors’ Timely Access to Care Act. [TY @RepDelBene@MikeKellyPA@RepBera@RepLarryBucshon for introducing this vital measure.]
•Detailed look at official US healthcare spending estimates through 2019 using data from @CMSGov
•Preliminary estimates of 2020 health spending from @Altarum
ama-assn.org/system/files/2…2/ •Health spending was 17.7% of GDP in 2019 and increased by 4.6% to $3.8 trillion ($11,582 per capita).
•Spending in hospital care (6.2%) and prescription drugs (5.7%) grew faster than physician services (4.2%) in 2019.