Jul 26, 2024 | Uncategorized
Due to the challenges physicians have faced in recent years, many are experiencing burnout and exhaustion. To address this, the American Medical Association (AMA) has developed a plan aimed at boosting morale. Continue reading to learn more about these developments.
The AMA has announced the AMA Recovery Plan for America’s Physicians to tackle the pressing challenges facing the nation’s doctors. Physician burnout was already a national concern before the coronavirus pandemic, and the pandemic has exacerbated this issue to crisis levels. The Association of American Medical Colleges projects a shortage of 37,800 to 124,000 physicians by 2034. AMA President Gerald Harmon, MD, emphasized the urgency of the situation, stating, “America’s doctors are a precious, irreplaceable resource. Physician shortages, already severe before COVID, have nearly become a public health emergency. If we don’t succeed with this Recovery Plan, attracting young talent to medicine and addressing the shortage will be even more difficult.”
The Recovery Plan focuses on five key areas:
- Supporting telehealth services, including insurance coverage
- Reforming Medicare payment for physician services
- Preventing “scope creep” that expands the practice scope of non-physicians, such as nurse practitioners
- Reforming prior authorization to reduce administrative burdens and avoid care delays
- Addressing physician burnout and reducing the stigma around mental health for physicians
Expanding Telehealth The pandemic led to unprecedented growth in telehealth, with 90% of physicians adopting it for patient care. Continuing telehealth services benefits both physicians and patients. Harmon noted, “The Centers for Medicare & Medicaid Services ensured that telehealth payment rates were equivalent to in-person services, even for audio-only visits. This has proven to be a viable option, offering safety, convenience, and time savings for patients. In rural areas, where geographic barriers pose significant travel challenges, digital health is invaluable.” Harmon stressed the importance of preserving telehealth advancements, saying, “Patients and physicians overwhelmingly support the continuation of telehealth post-pandemic. We are working to update laws and regulations to make this permanent.”
Reforming Medicare Physician Payment For years, Medicare reimbursement for physician services has been inadequate, creating financial uncertainty for physician practices. Harmon explained, “Medicare physician payments, the only healthcare delivery component subject to budget neutrality, have fallen 20% when adjusted for inflation since 2001. Legislative and regulatory changes during the COVID pandemic threatened a 10% cut in Medicare payments this past January. Thanks to the AMA and other medical organizations, Congress averted these cuts at the last minute—a major victory. However, we shouldn’t face this annual uncertainty. We need a permanent solution to ensure the economic viability of physician practices.”
Harmon underscored the need for payment reform, saying, “Predictable financial returns are essential for investing in costly infrastructure like new technologies and treatments. We are done with short-term fixes and looming cuts.”
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Jun 5, 2024 | Uncategorized
Summer is here, and many people are spending more time outside, swimming, and taking vacations. It is crucial to wear sunscreen to protect yourself from the sun. Read below for more information from the American Academy of Dermatology about the importance of sunscreen!
With Memorial Day marking the unofficial start of summer and the reopening of many beloved outdoor activities after the COVID-19 shutdown, it’s more important than ever to remember your sunscreen—especially after many of us spent months indoors. The American Academy of Dermatology (AAD) offers a great two-minute video and five tips for proper sun protection.
So get outside, enjoy your favorite activities, and don’t forget to apply that sunscreen. It’s finally summer! Click here to read more about sunscreen from the AAD.
May 29, 2024 | Uncategorized
Amazon In The Healthcare Space
The mere threat of Amazon.com Inc. entering the health care market has already started transforming U.S. health care, and not necessarily for the better. This looming presence has accelerated consolidation, leading to potential consumer disadvantages.
The speculation about Amazon’s involvement prompted two of the largest pharmacy benefit managers, CVS Health Corp. and Express Scripts Holding Co., to merge with major insurers, Aetna Inc. and Cigna Corp. These mergers consolidate more of the U.S. health care system under fewer companies. While the merging companies claim this will reduce costs for consumers and the nation, the reality is likely to be more complex and less favorable.
About The Mergers
These mergers were made possible partly due to the Federal Trade Commission and the Department of Justice blocking the mergers of Anthem Inc. with Cigna and Aetna with Humana Inc. These mega-insurers would have been too preoccupied with their own integrations to pursue such vertical deals and would have been too large to be acquired by other insurers.
UnitedHealth Group Inc. has also played a significant role in motivating these mergers. It pioneered aggressive diversification by acquiring a large PBM in 2015 and through its Optum health-services unit. Its success in patient enrollment, revenue growth, and market valuation has set a benchmark, inspiring similar strategies among its peers. Additionally, profit pressures on PBMs likely made them more open to merging with insurers.
However, Amazon’s potential entry into the health care market is a significant factor driving these deals. Amazon’s technological capabilities, long-term investment approach, vast appetite for new ventures, and tolerance for thin margins have unsettled investors, especially those involved in the industry’s middleman roles. If these mergers are finalized, the result will be unprecedented market concentration, with the three largest U.S. PBMs tied to three of the largest insurers.
Effects On Prescriptions
CVS, Express Scripts, and UnitedHealth currently process over 70% of all U.S. prescriptions. Post-merger, three companies will manage the insurance of over 90 million people, process more than 3.5 billion prescription claims, and generate over $500 billion in revenue. While not every American will have both their medical and drug benefits managed by the same company, many more will in the future.
These integrated companies will have more comprehensive information about their customers and a greater ability and incentive to manage total health spending. UnitedHealth is already deeply integrated, with investments in ambulatory surgery centers and physician groups. The merger of CVS and Aetna, which adds retail pharmacies and primary care clinics to the mix, could significantly impact patient lives.
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May 27, 2024 | Uncategorized
The American Medical Association (AMA) recently sent a letter to congressional leaders advocating for updates to the Medicare Physician Payment System. Following a Medicare Payment Advisory Commission (MedPAC) report, the AMA has urged Congress to implement a stable annual payment rate that aligns with inflation and practice costs.
The MedPAC report, presented to Congress on March 15, 2022, recommended maintaining the freeze on Medicare physician payment rates and not increasing them for 2023. The AMA has expressed significant concerns about this recommendation, emphasizing that it would negatively impact patient access to care as practice costs rise.
MedPAC’s report stated that despite the decline in Medicare service volume and revenue due to the pandemic, Congress provided substantial relief funds to clinicians. MedPAC expects these volumes and revenues to rebound to pre-pandemic levels by 2023. However, the AMA argues that financial challenges persist for physicians. They cite ongoing fiscal uncertainties related to the COVID-19 pandemic, statutory payment cuts, the consistent lack of inflationary updates, and significant administrative barriers as major issues affecting the stability of the Medicare physician payment system.
Inconsistency In Recommendation
The AMA also highlighted the inconsistency in MedPAC’s recommendation to freeze physician payment rates while CMS projects an 80 percent increase for Medicare Advantage plans in 2023. Data from the Medicare Trustees show that Medicare physician pay has increased by only 11 percent from 2001 to 2021, with one-third of that increase coming from a temporary 3.75 percent update set to expire this year. In contrast, Medicare hospital and skilled nursing facility payment rates have increased by over 60 percent during the same period. When adjusted for inflation, Medicare physician payment rates have declined by 20 percent over the past two decades, while the costs of running a medical practice have risen by 39 percent since 2001.
Additionally, Medicare physician fee schedule spending per enrollee has declined by 1 percent over the last ten years, while other Medicare benefits spending has significantly increased. For instance, Part B fee-for-service spending per enrollee, excluding physician fee schedule spending, rose by 42 percent over the last decade. Part A fee-for-service spending increased by 3.6 percent, Part C spending by 29.4 percent, and Part D spending by 20 percent.
Free Set To Continue Until 2026
The Medicare physician payment freeze is set to continue until 2026, after which payment updates will resume at a rate of 0.25 percent per year, far below the rate of medical or consumer price index inflation. The AMA warns that unless Congress updates Medicare physician payments to reflect inflation, the gap between payment rates and rising practice costs will continue to widen.
The AMA also referenced a May 2021 study that revealed the high costs of compliance with the Medicare Merit-Based Incentive Payment System (MIPS), amounting to around $12,800 and over 200 hours per physician annually. Furthermore, physicians have not been able to receive annual incentive payments for Medicare Advanced Alternative Payment Models (AAPM) due to the lack of transition opportunities.
The AMA stressed that financial hardships, burnout, and stress are driving many physicians to consider leaving their practice within two years. While expressing gratitude to Congress for the financial relief provided during the pandemic and for preventing a 10 percent physician payment cut in 2022, the AMA urged officials to collaborate with the physician community to develop solutions to the systemic issues plaguing the Medicare physician payment system.
Original article published on revcycleintelligence.com
May 25, 2024 | Uncategorized
Colorado Opioid Epidemic
A spotlight analysis by the American Medical Association (AMA), Colorado Medical Society (CMS), and Manatt Health reveals significant progress in Colorado’s efforts to address the opioid epidemic. The report highlights reforms that have been implemented, while also recommending further steps for policymakers, insurers, and physicians to save more lives.
Analysis Information
The analysis found that Colorado has made notable strides in increasing access to evidence-based treatment for substance use disorders. Several pilot projects have improved care for patients with pain, and increased access to naloxone, the opioid overdose-reversing drug, has saved thousands of lives. “We conducted this analysis because it’s essential that policymakers know what is working and where additional progress can be made,” said AMA President-elect Dr. Patrice A. Harris, who also chairs the AMA Opioid Task Force. “Colorado has implemented many important policies that are impacting patients’ access to care. Using this momentum, we think Colorado can go even further to save lives of those affected by opioid use disorder.”
This Colorado study is the second in a series of individual state analyses by the AMA, following a recent study on Pennsylvania. Based on data, policy reviews, and discussions with key policymakers, the analysis identified four key areas of success in Colorado.
4 Key Areas Of Success
- Adoption of Policies and Funding to Increase Access to Medication-Assisted Treatment: Initial steps have been taken to reduce administrative barriers, increase funding to address workforce issues, and expand Medicaid coverage in residential settings.
- Compliance with Mental Health and Substance Use Disorder Parity Laws: The Colorado Division of Insurance is reviewing insurers’ conduct and has established an ombudsman’s office to help patients access behavioral health care.
- Increasing Access to Non-Opioid Pain Management for Medicaid Patients: Coverage has been extended to non-opioid prescription medications and alternative therapies, such as physical and occupational therapy, and additional behavioral health care options.
- Expanding Access to Naloxone: Early legislation, a standing order for naloxone, Good Samaritan protections, and the elimination of prior authorization for naloxone under Medicaid have been implemented.
“This analysis comes at an important time for Colorado,” said Dr. Debra Parsons, CMS President. “Over the last six years, Colorado has developed policies, enacted laws, and made significant strides in uniting stakeholders to reverse the opioid epidemic. While we continue these successful initiatives, we must closely evaluate their effectiveness to ensure we are directing our efforts appropriately.”
The analysis also highlighted the work of the Colorado Consortium for Prescription Drug Abuse Prevention, which has united hundreds of stakeholders and continues to develop a data-driven dashboard to help direct resources to areas of greatest need. Additionally, the report identified areas for further improvement:
- Eliminating Barriers to Treatment: Further steps are needed to enforce mental health and substance use disorder parity.
- Expanding Access to Medication-Assisted Treatment Providers: Especially in rural areas of the state.
- Leveraging Successful State Pilots: To increase access to multimodal pain care and comprehensive benefit and formulary designs.
- Linking Naloxone Recipients to Follow-Up Treatment: To begin and sustain recovery.
- Evaluating State Policies and Programs: To determine what is improving patient care and reducing opioid-related harms, and to identify any unintended consequences of current policies.
“Many recommendations in this report, especially those related to commercial insurance—such as improving enforcement of mental health parity and conducting more comprehensive reviews of addiction professionals in insurers’ networks—are fair and reasonable steps we can tackle immediately,” said Michael Conway, Colorado Insurance Commissioner and head of the state’s Division of Insurance. “We look forward to working with Colorado’s health insurers and physicians to implement solutions that ensure consumers receive the care they need to help end our state’s opioid epidemic.”
Click here to read the original article on cms.org.
May 23, 2024 | Uncategorized
Are you worried about surprise medical bills? The recently passed No Surprises Act aims to protect consumers, but many people are still unsure about its implications. Fortunately, several organizations have added resources to help you understand the new legislation. Read on to learn more.
Advisories, information sheets, and FAQs are now available to assist hospitals, health systems, physicians, and consumers in navigating the new rules against surprise billing. Despite ongoing legal challenges, key elements of the No Surprises Act took effect on January 1, and various stakeholder organizations are offering guidance to their members.
Latest Updates:
American Hospital Association (AHA):
- On Friday, the AHA published a legislative advisory summarizing the No Surprises Act and its key takeaways. The advisory includes a 15-page detailed summary of the rules. “The hospital and health system field strongly supports protecting patients from surprise medical bills,” the AHA stated. They believe this legislation is a significant step forward in patient protection. The AHA’s advisory webpage also links to additional resources, including an FAQ on good faith estimates for uninsured/self-pay patients, details about the AHA/AMA lawsuit challenging billing dispute resolutions, and information on CMS guidance
American Medical Association (AMA):
- Also on Friday, the AMA published an advocacy update for physicians. It includes a new toolkit focusing on three key issues: notice-and-consent requirements for out-of-network care at in-network facilities, rules about emergency and post-stabilization care, and good faith estimates for self-pay and uninsured patients. An AMA Advocacy Insights webinar on January 20 will explore these topics further.
Centers for Medicare & Medicaid Services (CMS):
- CMS added new online resources for consumers explaining their new billing protections effective January 1. These include protections for emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. The CMS website states, “Through new rules aimed at protecting consumers, excessive out-of-pocket costs are restricted, and emergency services must continue to be covered without prior authorization, regardless of network status.” The page also provides links to resources that explain what surprise bills are and the new consumer protections.
Additional resources for hospitals and health systems are available from the Healthcare Financial Management Association and the Medical Group Management Association.
For more details, visit the original article on healthleadersmedia.com.
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