Prochant’s Post

📢 AMA Survey Reveals Impact of Prior Authorization on Patient Care A new survey by the American Medical Association highlights the adverse effects of prior authorization (PA) on patient care. Key findings include: - 94% of physicians report delays in care due to PA. - 25% attribute serious adverse events to PA, including hospitalizations and life-threatening conditions. - 95% say PA increases physician burnout. PA often leads to unnecessary spending and administrative burdens, undermining practice sustainability. Ni2 Health & Infinix advocate for greater insurer accountability and transparency to protect patient care quality. #Ni2 #Infinix #Healthcare #PriorAuthorization #PatientSafety #PhysicianBurnout

The right kind of ownership transition plan can mitigate challenges and ensure physician (and patient) retention and the best patient care. https://ow.ly/mvQC50Smke0

One physician, Carry Passik, MD, here sums up the state of provider reimbursement in 2024 for those caring for all of us. His particular expertise saves lives virtually everyday. This at a time of widespread burnout and physicians leaving medical practice at rates higher than we have seen in years. "The reimbursement for coronary artery bypass, the most common procedure that I perform, is now less than 1/3 of what it was when I first started in practice in 1988. And that is in 2023 dollars! When the reimbursement for coronary bypass (a routine but very complex procedure), which includes 90 days of global care, has become 1/10 of what it would cost to get your bathroom remodeled, there is something wrong with the system," Why physician pay bumps aren't enough https://lnkd.in/gEGGusaF

Good Tuesday Afternoon, MABillers! CMS to address unusual catheter billing affecting ACOs. Premier and 10 health care organizations sent a letter to CMS urging the agency to remove catheter spending claims from all accountable care organization financial calculations due to unusual "Medicare spending outside their control." Atypical billing caused spending for two catheter codes to surge from $153 million in 2021 to $3.1 billion last year, the groups wrote, adding that "[five percent] of ACOs would see an impact ranging from $166 per patient per year to well over $1,000 per patient per year" if the agency will not alter the calculations. https://lnkd.in/eSwErQRM #MAB #CMBS #CPSP #MARA #MedicalBilling #Medical #Billing #Reimbursement #Credentials #Training #RemoteWork #Remote

Medicare's proposed Physician Fee Schedule (PFS) calls for an overall reduction in payments of 2.8%, however organizations such as the American Medical Association (AMA), Medical Group Management Association (MGMA), and American Medical Group Management Association (AMGA) have called for Congress to amend this rule during the 60 day comment period. The groups primarily citing five consecutive years of payment rate decreases despite rapidly rising practice costs. It seems that MACRA's freeze on Medicare's physician payments as a fix of the Sustainable Growth Rate formula has not resulted in any change in the debate that occurs each year when the proposed PFS is released. If you or your organization would like to understand how the proposed rule will impact your practice(s) and how Blue can potentially mitigate its impact, please feel free to reach out.

Value-based care, anyone? If shared quality and outcomes are the foundation of VBC networks, MSSPs, and ACOs, why are hospital-owned physicians and groups still compensated based on volume (relative value units)? This RVU-based compensation system can only last until legislation appears on the horizon. Quantity will never equal quality. #ValueBasedCare #HealthcareReform

Physician autonomy is misunderstood…

Becker’s CFO Report shared sobering Prior Authorization data collected in an American Medical Association survey earlier this week. https://lnkd.in/gw8_7-yX #PatientExperience, patient treatment, and #staffburnout are just a few of the major impacts of prior authorization inefficiencies. Is your staff spending hours away from patient care to complete paperwork only to receive denied claims? Partnering with an expert in prior authorization work is an effective way to resolve challenges. Learn more about outsourcing prior auths and other RCM work to improve outcomes for your organization here https://lnkd.in/g-fa3w3S #RCM #PriorAuthorizations #LYPHealthManagement

Good Tuesday Afternoon, MABillers! CMS to address unusual catheter billing affecting ACOs. Premier and 10 health care organizations sent a letter to CMS urging the agency to remove catheter spending claims from all accountable care organization financial calculations due to unusual "Medicare spending outside their control." Atypical billing caused spending for two catheter codes to surge from $153 million in 2021 to $3.1 billion last year, the groups wrote, adding that "[five percent] of ACOs would see an impact ranging from $166 per patient per year to well over $1,000 per patient per year" if the agency will not alter the calculations. https://lnkd.in/eYn9F87k #MAB #CMBS #CPSP #MARA #MedicalBilling #Medical #Billing #Reimbursement #Credentials #Training #RemoteWork #Remote

When seeking care with a Kaiser Permanente Physician, members can rest assured that 'Prior Authorization' for necessary services is not a concern. At KP, our physicians rely on decades of evidence-based medical practices and utilize the World's most sophisticated EMR, eliminating the need for prior auth and pre-cert requests. This approach not only enhances the patient experience but also reduces waste in the care continuum and the system, ultimately leading to improved health outcomes. #Healthcare #PatientExperience #KaiserPermanente #EvidenceBasedMedicine