From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that may interest our readers. Today’s post originally appeared in The Lincoln Journal Star, titled “When Insurance Fails.” In the op-ed, neurosurgeon Jeremy Hosein, MD, discusses the misuse of prior authorization, which delays care, prolongs suffering and adds significant administrative costs to health care. Read More
From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that may interest our readers. Today’s post originally appeared on 1819 News on April 21, titled “Ending the Health Insurance Monopoly Will Make Life Healthier for Alabamians.” In the op-ed, Richard P. Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., discusses why broadening health insurance coverage options in Alabama will improve the state’s health care system.
Alabama is tied with Alaska as the least competitive insurance market in the nation, limiting patient options, hurting hospitals and physicians and feeding the insurance industry. Lack of competition also impacts prior authorization, a system where insurance companies must approve certain surgeries before they agree to pay for them, despite the physician and patient deciding upon a personalized treatment plan. Dr. Menger states that this is an intentional delay tactic, and the cumbersome apparatus frustrates families, hurts patients and burns out physicians.
Dr. Menger argues that the arc of reform needs to bend towards the injection of competition between and within state lines — With that will come better products, lower prices, higher quality and more innovation.
Click here to read the full op-ed by Dr. Menger.
Editor’s Note: Organized neurosurgery aims to improve competition in the health care system by broadening health insurance coverage options, increasing scrutiny of hospital and other health care consolidation, removing restrictions on physician ownership of hospitals and other ancillary services and establishing network adequacy standards.
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From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that may be of interest to our readers. Today’s post originally appeared on AL.com on March 17, titled “Guest opinion: Alabama hospitals need competition” In the op-ed, Richard P. Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., discusses why the “game of Hospital Monopoly needs to end.” Read More
From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will be of interest to our readers. Today’s post originally appeared in MedPage Today on Jan. 21. In the op-ed, neurosurgeons Anthony M. DiGiorgio, DO, MHA, and Praveen V. Mummaneni, MD, MBA discuss the burden of electronic health records (EHR) at their institution, the University of California San Francisco. Read More
The Medicare physician payment system is on an unsustainable path that has failed to keep up with inflation over the years, threatening patient access to care. The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) are actively engaged in preventing steep Medicare payment cuts and preserving patient access to care through the Surgical Care Coalition. The coalition is in year three of its campaign to stop these cuts and implement lasting changes to the physician payment and quality improvement systems. Read More
From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in The Hill on Nov. 13, 2021. In the op-ed titled “Physician pay cuts are another threat to independent practices,” Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., discusses how the 9% Medicare physician pay cuts for medical services starting Jan. 1, 2022, will have enormous consequences for the entire health care system. Read More
The Children’s Health Insurance Program (CHIP) is a health insurance program that provides coverage to children from low-income families. CHIP was established in 1997 with strong bipartisan support and is an essential state-federal partnership. As many as 15% of children lacked health insurance coverage at the time. According to the American Academy of Pediatrics (AAP), Medicaid and CHIP provided health insurance to more than 50% of U.S. children in 2012, making both programs combined the nation’s largest insurer. These children and their families depend on federally subsidized state Medicaid for their health insurance. Read More
From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in Health Affairs on Aug. 26, 2021. The article, “A Way Forward For The Imaging Appropriate Use Criteria Program: Aligning Quality Metrics,” discusses proposed changes to the Centers for Medicare & Medicaid Services (CMS) calendar year 2022 proposed Medicare Physician Fee Schedule (PFS) Rule and implementation of the Appropriate Use Criteria (AUC) program. Mandated by the Protecting Access to Medicare Act (PAMA), the AUC program requires physicians ordering advanced diagnostic imaging to consult with AUC using an approved clinical decision support mechanism before the radiologist can provide the scan.
As the Health Affairs piece points out, following the release of the PFS, the House Appropriations Health Subcommittee included in its report a provision for CMS to inform Congress about the implementation of the AUC program, including any challenges and successes. The AANS and the CNS have urged Congress to repeal the AUC program, given the additional burdens on physicians and potential delays in imaging services. At the very least, the neurosurgical societies have recommended that Congress adopt legislation that directs CMS to incorporate AUC for diagnostic imaging into the existing Quality Payment Program.
Click here to read the full article in Health Affairs.
Editor’s Note: We encourage everyone to join the conversation online by following @Neurosurgery and using the hashtags #Neurosurgery and #Medicare.
From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in The American Spectator on July 21, 2021. In the op-ed, Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala. discusses how H.R. 3173, the Improving Seniors’ Timely Access to Care Act, could bring transparency to the process of prior authorization in Medicare Advantage (MA) plans. Read More
From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in The Hill on Jan. 14, 2021. In the op-ed, Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., highlights the need to streamline the cumbersome process of prior authorization for medical and surgical procedures performed through the Medicare Advantage program. Prior authorization is a tool insurance companies use to limit the services they provide for their customers. “Reducing the footprint of prior authorization bends the arc towards that proper direction of reform,” according to Dr. Menger.
Click here to read Dr. Menger’s full article in The Hill.
Editor’s Note: We encourage everyone to join the conversation online by using the hashtags #FixPriorAuth and #RegRelief.
