The AMA President, Jesse Ehrenfeld, MD, says he is concerned about “government interference in the practice of medicine.” He is also unhappy with Medicare payments. But, his complaints focus heavily on the behaviors of the health insurers and corporate interference in the practice of medicine. Why is he not calling out the health insurers?
The health insurers impose huge administrative challenges on physicians, in the form of paperwork and prior authorization requirements that drive up costs and create obstacles to care, which Ehrenfeld decries.
In fact, Ehrenfeld claims progress for the AMA because it successfully advocated for some prior authorization fixes in Medicare Advantage, without criticizing the insurers offering Medicare Advantage plans and imposing all sorts of valueless prior authroization requirements. Why is Ehrenfeld withholding criticism of the Medicare Advantage plans when his members have said that the insurers offering these plans are denying, delaying and downgrading needed care to the detriment of their patients?
One in three AMA members have said that insurers’ prior authorization rules have “led to a serious adverse event for a patient in their care.” One in four physicians have said that prior authorization has led to an unnecessary hospitalization. And, almost one in five physicians have said prior authorization has led to “a life-threatening event or required intervention to prevent permanent impairment or damage.” Nine percent of physicians report that “PA has led to a patient’s disability/ permanent bodily damage,”
Ehrenfeld says that physicians are facing a 26 percent revenue cut in Medicare. To what extent are the Medicare Advantage plans to blame for their inadequate payments, as a result of low rates and inappropriate claim denials? We know that the insurers deny payment to physicians inappropriately and, sometimes, often.
The AMA has a new website called Fix Medicare Now. It opposes proposed cuts to Medicare provider payments. But, it also talks about promoting “value-based” care. In my book, that’s code for give the insurance industry the money to oversee care and coverage, to come between patients and their doctors. I hope that’s not what the AMA is saying.
Here’s more from Just Care:
- Underpayments lead hospitals and specialists to cancel Medicare Advantage contracts
- 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- More than one in four older adults skip care because of cost
- If you’re in a Medicare Advantage plan, watch out! Your doctor or hospital might no longer be in-network
- Proposed new prior authorization rules unlikely to improve access to care for people in Medicare Advantage
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