Providers Still Dealing With Prior Authorization Problems
A recent survey conducted by AMA reveals that practices are reporting an average of 37 prior authorization requests each week, eating up an average of 16 hours of both physician and staff time. Check out the article, below, by Health Leaders Media, outlining the results of the survey.nnThe healthcare industry hasn’t eliminated the hassles for providers that prior authorization often entails, but they’re getting closer, several speakers said here at Healthcare Information and Management Systems Society (HIMSS) annual meeting.nn“Studies have shown that prior authorization is the biggest ‘pain point’ among providers,” Pam Jodock, senior director of healthcare business solutions at HIMSS, said at a Tuesday morning meeting session. “The issue is not automation; it’s the business processes to which automation would be applied.”nnThe six groups represented at the morning session are hoping to develop consistency in the requirements for getting a prior authorization and reducing the number of treatments and procedures that require it, she added. “The fact that we have six [groups represented] is because this is a critical issue of everybody on the stage today.”nnCLICK HERE TO READ MORE.nnThis article originally posted on HealthLeadersMedia.com.
Former Aetna CEO claims Obamacare is flawed, read more below about what former Aetna CEO Ronald William’s has to say about Obamacare. nnSince the Affordable Care Act became law in 2010, making the math work has been a real challenge. For Obamacare to be sustainable, the insurance “risk pool” equation has to work. Premiums from young, healthy consumers have to exceed medical care costs for older people. Was there a problem with the formula?nn”I think it was flawed,” former Aetna CEO Ronald Williams told CNBC’s On The Money in an interview.nn”In health care you really need a balance of people who need health care today, tomorrow and in the future,” he said. “And the rate structure was set in a way that those who needed health care today got the most affordable premiums. That means typically older citizens got a much better deal.”nnWhile the Affordable Care Act was being created, Williams often met with President Obama or his staff, and testified before Congress as Aetna CEO from 2006 to 2010. Obamacare has a “structural imbalance” that resulted in higher costs for healthier, younger people, Williams said, but lower costs for those who are “older and more likely to need care.”nnAs a result, “Younger participants in the exchanges and who purchase individual insurance paid more and they just didn’t see the value, and therefore they did not come forward and sign up,” he said. Williams said that because young adults chose not to sign up for ACA, the insurance industry is “missing their premiums and that’s causing the overall rate of increase to be greater.”nnThat, in turn, is helping “make the insurance pool unsustainable financially,” he said.nnSince stepping down as Aetna’s chief executive in 2010, Williams has been CEO of his own consultancy, RW2 Enterprises. He’s also a director of American Express, Boeing, and Johnson & Johnson. With President Trump vowing to dismantle the Affordable Care Act, the public doesn’t yet know what will replace it.nnWilliams said what is needed is “much more competition” and lower cost, more flexible plans so that consumers have “a range of options as opposed to a ‘one-size-fits-all’ approach.”nnWhile we hear a lot about repealing ACA, the jury is still out on what comes next. The process of getting Obamacare created took years of negotiating and planning from various and multiple parts of the health care system. Is the same thing going to have to take place again to remake the Affordable Care act?nn”I think it does,” Williams said. “We need to make changes in a thoughtful way. We need the input of hospitals, physicians, pharmaceutical companies, health insurers and consumers.”nnThis 
nnAnthem CEO Joseph R. Swedish appeals the federal judge’s decision to merge with Cigna and claimed merger would save consumers $2 billion in medical costs. Read more about the Anthems appeal below.nnAnthem CEO Joseph R. Swedish said he was “significantly disappointed” with the federal judge’s decision and claimed the merger would save consumers more than $2 billion in medical costs annually.nnAlmost immediately after the court ruling that shut down its plans to merge with Cigna in a $54 billion deal, Anthem announced Thursday that it will appeal the decision.nnOn Wednesday Judge Amy Berman Jackson of the D.C. District Court agreed with antitrust regulators that the merger would create an insurance giant that would unfairly control much of employer-provided health coverage in the country.nn”The company promptly intends to file a notice of appeal and request an expedited hearing of its appeal to reverse the Court’s decision so that Anthem may move forward with the merger, which was approved by over 99% of the votes cast by the shareholders of both companies,” the company said in a statement.nnJoseph R. Swedish, chairman, president and chief executive officer of Anthem, said he was “significantly disappointed” and claimed the merger would save consumers more than $2 billion in medical costs annually.nn”If not overturned, the consequences of the decision are far-reaching and will hurt American consumers by limiting their access to high quality affordable care, slowing the industry’s shift to value-based care and improved outcomes for patients, and restricting innovation which is critical to meeting the evolving needs of healthcare consumers,” Swedish said.nn”Moving forward, Anthem will continue to work aggressively to complete the transaction while remaining focused on serving as America’s valued health partner, delivering superior health care services to our approximately 40 million members with greater value at less cost.”nnIn the parallel case argued on the same grounds, a federal judge last month blocked the proposed $37 billion merger of Aetna and Humana. It is not known if that decision will be appealed.nnThis 
The proposed merger of Aetna Inc. and Humana Inc. was blocked by a United States Federal Judge earlier this week. Read more about this in the article below. nnA U.S. judge blocked on Monday health insurer Aetna Inc’s proposed $34 billion acquisition of smaller peer Humana Inc, raising the stakes for rival Anthem Inc as it battles to close a $54 billion deal to buy Cigna Corp. The ruling is another victory for the U.S. Justice Department, whose antitrust enforcement became much more aggressive during former U.S. President Barack Obama’s eight years in office, which ended last week.nnObama’s successor, Donald Trump, and a Republican-controlled legislature are seeking to undo much of the Affordable Care Act, better known as Obamacare. The law reshaped the U.S. healthcare industry by mandating health insurance and creating online exchanges where consumers can shop for individual policies and get subsidies. Aetna, Humana, Anthem and Cigna had cited Obamacare as one of the main reasons their industry needed to consolidate to cope with the costs of expanding coverage. Their shares ended trading on Monday at levels that suggested that investors continued to see little chance that the two mergers would happen.nnThe U.S. Justice Department filed a lawsuit last July to block Aetna’s acquisition of Humana and Anthem’s acquisition of Cigna, arguing that the two deals would lead to higher prices. Anthem and Cigna are still waiting for a judge to rule on whether their merger can proceed. Investors have long been skeptical that this deal can be approved, and Leerink Research analyst Ana Gupte reiterated on Monday that she expected to also see this deal blocked. In his ruling, Judge John Bates of the U.S. District Court for the District of Columbia said the proposed deal would “substantially lessen competition” in the sale of Medicare Advantage plans in 364 counties in 21 states that the Justice Department had identified in its complaint, and on the Obamacare exchange in three Florida counties.n
The Affordable Care Act (Obama Care) looks to be the first target of a Republican dominated House, Senate and President!nnMuch in the ACA is entangled in the current tax code. It will not be as simple as defunding it. The employer and individual mandates, the premium tax credit, the (so called) Cadillac Tax, the earned income surtax (just to name a few examples) will all have to be revisited.nnBe on the lookout for big and potentially complicated tax changes as our President and legislators unwind this enormous law we now call Obama Care.nnWhile we are at it, just an FYI: The shorter depreciation schedule for race horses appears to be expiring!nnPlease consult your tax professional for more details and information prior to making any changes!nn
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners