JustCare

Tag: AMA

  • AMA asks Congress for help saving independent medical practices

    AMA asks Congress for help saving independent medical practices

    In a Statement to Congress, the American Medical Association (AMA) asks for help saving independent medical practices. The AMA wants higher physician pay and government intervention to address systemic inequities and administrative burdens, recognizing the calamitous state of our health care system. “This is not just a call for action; it is a plea to safeguard the heart of American health care before it is too late.”

    What’s concerning is that the AMA does not call out the significant role of corporate health insurers in destroying our health care system. The AMA appears to like the higher rates the physicians receive from corporate insurers and doesn’t want to give those up; rather, it wants higher Medicare rates.

    The AMA highlights many big health care problems, without attribution to the insurers. The practice of medicine is not what it used to be. Small independent practices are vanishing. In their place, big corporations are buying up physician practices and intervening in the practice of medicine. (UnitedHealthcare, for example, now controls 10 percent of physicians in the US.)

    Physicians are increasingly no longer free to make treatment decisions for their patients. Rather, insurance companies second-guess their decisions, coming between them and their patients. The consequences can be dire for the patients, as the data indicates. The AMA also recognizes the need for “expanded support for rural and underserved areas” and “a health care infrastructure secured from emerging threats.”

    Of course, it’s the insurers who are responsible for the bulk of our health care system’s failings. They implement prior authorization protocols that harm providers and patients alike. But, while the AMA doesn’t like these protocols, it’s letter to Congress makes it seem as if the insurers are forced to use prior authorization: “This requirement for insurers to approve treatments before they can be administered not only delays diagnosis and treatment but also involves substantial paperwork and diverts critical resources and time that could be better spent on direct patient care.”

    The AMA only indirectly calls out insurers for their role in underpaying providers, undermining competition and patient choice. After all, it’s the insurers who are failing to pay rural and other hospitals appropriately for the care they provide, threatening their very being, forcing many to close, and making it harder for people to access care.

    The question is whether the AMA will ever join forces with patients to call for guaranteed affordable health care for all. Until then, it will be hard to move Congress to overhaul our health care system.

    Here’s more from Just Care:

  • AMA wants Medicare to pay doctors more

    AMA wants Medicare to pay doctors more

    The AMA is telling Congress not to cut Medicare payments to physicians. The AMA would be smart to speak up for patients and the problems their physicians have getting patients the care they need in Medicare Advantage. The Medicare Advantage plans are getting tens of billions in overpayments, money that could go to pay physicians higher rates. 

    The AMA has spoken directly against prior authorization policies, the policies that insurers use in Medicare Advantage and in the commercial market to delay and deny care. The policies are all different in each Medicare Advantage plan. And, CMS is hard-pressed to regulate them. But, one AMA survey finds that physicians say these policies are often not evidence-based and can result in premature death and disability, along with other patient harms.

    Meanwhile, Medicare cut physician rates by 3.4 percent on January 1. Since the deadline for government funding is January 19, budget negotiations present an opportunity for Congress to reverse that cut.

    Is the AMA whining about nothing really when it comes to Medicare rates? Will doctors continue to treat people with Medicare even given the Medicare rate cuts? It’s hard to say. The Medicare Payment Advisory Commission, MedPAC, supports raising physician rates in keeping with inflation.

    MedPAC will report to Congress in March on whether Medicare physician rates are appropriate or should be changed. Jesse Ehrenfeld, the AMA President, claims that “if you look at physician payments over time adjusted for inflation, rates actually fell  26% from 2001 to 2023.”

    Here’s more from Just Care:

  • Prior authorization in Medicare Advantage harms patients, sometimes severely

    Prior authorization in Medicare Advantage harms patients, sometimes severely

    MedPage Today reports on a poll finding that prior authorization requirements in managed care plans, such as Medicare Advantage, lead to patients needing hospitalization, becoming disabled or dying, according to one in three physicians. Why does Medicare allow prior authorization–with its often unjustified barriers to care–in Medicare Advantage plans?

    No one can deny that sometimes people get care that they don’t need. But, what makes health insurers able to determine what care is needed? On what do they base their decisions?

    As a general rule, health insurers are not held to account for their prior authorization policies. Yet, this AMA survey found that three in ten physicians say that health insurers rarely if ever use prior authorization criteria that is evidence-based. And, 91 percent of physicians say that insurer prior authorization criteria have a negative impact on their patients’ health outcomes.

    Almost one in five physicians (18 percent) said that an insurer’s prior authorization requirement resulted in a life-threatening event for a patient or a health outcome that “required intervention to prevent permanent impairment or damage.” On top of that one in 12 physicians said that their patients became disabled or physically harmed or died as a result of prior authorization requirements.

    Congresswoman Suzan DelBene of Washington State has a bill, Improving Seniors” Timely Access to Care Act, intended to standardize prior authorization programs in Medicare Advantage plans. It would require health plans to disclose their requirements and greater oversight of them.

    Some states limit or have introduced bills to limit insurers from using prior authorization, including New York, Texas, Illinois and Indiana.

    More than 1,000 practicing physicians completed the survey.

    Here’s more from Just Care:

     

  • Trump HHS pick is fierce opponent of Medicare and ACA

    Trump HHS pick is fierce opponent of Medicare and ACA

    President-elect Trump‘s choice of Tom Price to head the Department of Health and Human Services (HHS) sends a strong signal that the Trump Administration will be allied with Speaker Paul Ryan in repealing the Affordable Care Act. Price also is a fierce opponent of Medicare. He supports gutting both Medicare and Medicaid and rationing health care based on people’s ability to pay for it.

    As a Congressman and Chair of the House Budget Committee, Price has made his views on health care known. He authored a bill that turns over much control over health insurance to the industry, with the Orwellian name, Empowering Patients First Act. He supports health insurance regulations that allow insurers to charge older people significantly more than they may today and to sell policies that offer less than adequate coverage. And, he is opposed to subsidies to help people with low incomes afford their health care.

    If Price has his druthers, Congress would privatize Medicare and Medicaid, turning them over entirely to private insurance companies. Like Ryan, he wants to eliminate their guaranteed benefits and leave older adults, people with disabilities and people with low-incomes at the mercy of insurers, with inadequate coverage, in the health care marketplace.

    Just recently, Price’s Budget Committee released a plan that would have Congress automatically cut Medicare, Medicaid and Social Security substantially to pay for tax cuts mainly for the wealthiest Americans, which president-elect Trump and Congressional Republicans support. The Center for American Progress reports that under his plan, over ten years, Social Security would be cut $1.7 trillion, Medicare would be cut $1.1 trillion, and Medicaid would be cut by nearly $700,000 billion.

    And, even without Congressional action affecting our health care system, as head of HHS, Price will have tremendous power to drive changes in Medicare, Medicaid and health insurance in America. As head of HHS, Price will determine how laws are interpreted. He can choose for HHS to limit its oversight of health insurers or to stop spending money on enforcement or to revise provider payment policies.

    There’s no candy-coating what will happen if Ryan and Price get their way in Congress. Here’s what we should expect:

    • The ACA will be repealed, Medicare will no longer guarantee basic health care coverage, and Medicaid will likely be turned over to the states in the form of federal block grants.
    • Hospitals and doctors will ratchet up their charges.
    • Drug companies will increase drug prices.
    • Insurance companies will compete for business by keeping their premiums as low as possible for the young and healthy and denying coverage or charging high deductibles and out-of-pocket costs when people need care; people with costly conditions will be forced to pay exorbitant premiums as well as high deductibles and copays for coverage or forego care.
    • Insurers will restrict their coverage as much as possible and give people only a limited choice of doctors and hospitals. There may not be a guaranteed package of Medicare benefits.
    • Government will provide little oversight of the health care industry and/or will not hold insurers accountable for failing to deliver good quality care.

    The American Medical Association, AMA, and American Hospital Association, AHA, are both supporting Tom Price. They likely see deregulation of the health care industry as a way for doctors and hospitals  to charge higher rates and operate with less accountability. However, deregulation of the health insurance industry will ultimately bite doctors and hospitals in the back.

    If Price’s views prevail and Congress kills Medicare and Medicaid, insurers are more than likely to use their leverage to form narrow networks, keeping their enrollees from using costly specialists and specialty hospitals. Alternatively, insurers will raise out-of-pocket costs for specialty care so high that patients won’t be able to afford them, and doctors and hospitals will be left holding the bag.

    If you oppose deregulation of our health insurance system and an end to Medicare’s guaranteed benefits, please sign this petition and visit your Senators to make your views known.

    Here’s more from Just Care:

  • Should drug companies be allowed to advertise on TV?

    Should drug companies be allowed to advertise on TV?

    On November 17, 2015, the American Medical Association voted to support a ban on drug and medical device company advertising on TV. The AMA sees a negative impact from these ads and also says these ads lead to an increase in drug and device prices. Moreover, they say these ads lead individuals to ask for drugs which they don’t need, are more expensive than other treatment options, and can be harmful to them.

    In the last two years, there has been a 30 percent increase in the amount that drugs and device companies are spending on direct-to-consumer advertising, now at $4.5 billion annually. The AMA is particularly concerned with the cost of drugs, which rose almost five percent last year. They are often unaffordable to patients, even those with insurance, keeping them from getting needed care.

    Drug and device companies could only conduct extremely limited direct-to-consumer advertising until 1997 when the FDA loosened restrictions. For almost 20 years they have been advertising heavily to consumers, Yet, most people do not have the scientific or technical knowledge to understand whether a particular drug or device is right for them based on an ad.

    That notwithstanding, the ads do lead nearly three in ten people to talk to their doctor about a drug. And, two out of three of these people ask their doctors for the prescription.

    A recent Kaiser Family Foundation poll shows that about half the population thinks the drug company advertising is generally good. But, almost 90 percent of the public, Democrats, Republicans and Independents alike, supports FDA review of the ads for accuracy and clarity before they are aired.

    Given that prescription drug advertising drives up drug costs, the risk of harmful side effects from many drugs, along with FDA drug and device approvals that are sometimes not based on clinical evidence of safety and efficacy, do you think drug and device companies should be allowed to market directly to consumers? Please post your comment.