MedPAC Wrestles With How to Fix Deep Flaws in Medicare Advantage Quality Metrics
The methods used to compare quality between one Medicare Advantage (MA) plan and another are so seriously flawed that the system needs an overhaul, members of the Medicare Payment Advisory Commission (MedPAC) suggested last week. A commission review has determined the program “is costly and not a good basis for judging quality,” MedPAC principal policy […]
Medicare Advantage Plans Fielded 35 Million Prior Auth Requests in 2021
Over 35 million prior authorization requests were submitted to Medicare Advantage insurers in 2021, according to a new report from the Kaiser Family Foundation (KFF). Two million of these requests, or 6%, were fully or partly denied, according to Jeannie Fuglesten Biniek, PhD, associate director of the Program on Medicare Policy, and Nolan Sroczynski, MSPH, […]
Medicare Advantage Plans Take Top Spot in Shkreli Awards
Medicare Advantage plans took the top spot in this year’s Shkreli Awards, the annual list from the Lown Institute that calls attention to some of healthcare’s most greedy and unethical behavior. The plans’ penchant for defrauding or overbilling Medicare by an estimated $25 billion in 2020 alone by saying beneficiaries were much sicker than they […]
Report: Medicare Advantage Plans Wrongly Deny Care, Physician Payments
Medicare Advantage plans often denied medically necessary care to beneficiaries and payments to doctors that met Medicare coverage rules, according to a new report from the HHS Office of the Inspector General (OIG). OIG found that 13% of prior authorization requests that were denied met Medicare coverage rules, as did 18% of physician payment requests […]
EHR Pop-Ups Spur Better GDMT Implementation in Heart Failure
WASHINGTON — A large health system took advantage of its electronic health records (EHR) software to increase utilization of guideline-directed medical therapy (GDMT) in the outpatient setting. In the PROMPT-HF study, clinicians randomized to a clinical decision-support intervention got electronic alerts every time they accessed the EHR of a heart failure outpatient not on one […]
No Long-Term Cognitive Benefit in Fortified Baby Formulas
Infants raised on fortified formula milk showed no advantage in academic performance later on as adolescents, researchers found using data from England. No significant differences in U.K. math exam scores were found in students at age 16 who, as infants, had participated in clinical trials comparing formulas enriched with long chain polyunsaturated fatty acids (LCPUFAs), […]
Doc Groups Seek to Reinstate Ban on Step Therapy in Medicare Advantage
WASHINGTON — Are Medicare Advantage (MA) plans allowed to require patients to go through “step therapy” to get a medication or treatment they need? Yes — for now — but physician groups are trying to change that. “On August 7, 2018, CMS (the Centers for Medicare & Medicaid Services) issued a memo to MA plans […]