ADA ousts researchers then apologizes; Medicare Advantage reverses 95% of appealed denials; AMA takes on AI and corporate medicine — Morning Medical Update Weekly Recap

American Diabetes Association removes researchers from its annual meeting, then apologizes after backlash

Security and police escorted five experts out of Scientific Sessions over a journal editorial, and the backlash has already reshaped the association's leadership.

On June 5, security officers and local police removed five researchers from the American Diabetes Association’s (ADA’s) Scientific Sessions in New Orleans after they distributed copies of an editorial from the ADA's flagship journal, Diabetes Care, that criticized Trump administration cuts to biomedical research and National Institutes of Health (NIH) funding.

Among those barred from the meeting was Steven Kahn, M.B., Ch.B., the journal's editor-in-chief and the editorial's lead author. The ADA initially said the group was removed for distributing materials without prior approval, not for their viewpoints, and pointed to its nonpartisan obligations as a 501(c)(3) organization. The response intensified the criticism and more than 40 former ADA presidents and board chairs signed a letter of protest. President-Elect Jennifer Green, M.D., and Scientific Sessions Planning Committee Chair Mark Atkinson, Ph.D., resigned. On June 10, CEO Charles Henderson issued a video apology to the researchers and the diabetes community, said the association would commission an independent review and pledged to keep advocating for robust NIH funding. MedPage Today has more, including an on-the-scene video of the incident with police.

Medicare Advantage plans overturned 95% of appealed nursing home denials, OIG finds

A pair of federal reports renews scrutiny of prior authorization in post-acute care, with denials concentrated among the largest insurers and one UnitedHealth contractor.

The HHS Office of Inspector General released two reports this week examining how Medicare Advantage organizations handle prior authorization for post-acute care. Across the 19 largest plans, approximately 12% of requests for skilled nursing facility admission were denied in June 2024, but when enrollees appealed, plans overturned 95% of those denials, a rate the OIG said raises concerns that some patients were initially denied medically necessary care.

naviHealth, a UnitedHealth Group subsidiary that processed half of all skilled nursing requests, denied 14% of them, higher than plans reviewing requests internally. Nursing home residents were denied skilled care 40% of the time, nearly four times the rate for other enrollees. Insurers note the data predates recent voluntary reductions in prior authorization, while the OIG urged CMS to examine why so many denials are reversed on appeal.

AMA targets AI in coverage decisions, corporate ownership and names new president at its annual meeting

Delegates adopted policies aimed at keeping physicians in control of care and practices, and installed new leadership for the year ahead.

At its annual meeting in Chicago, the American Medical Association (AMA) House of Delegates adopted policies addressing several pressures facing independent practices. New artificial intelligence (AI) policy states that AI should support rather than replace physician judgment and opposes health plans using autonomous systems to deny care without physician review.

Delegates also strengthened the AMA's opposition to the corporate practice of medicine, calling for practices to remain majority-owned by actively practicing physicians and opposing noncompete and non-disparagement clauses.

On Medicaid, the AMA backed automatic exemptions from new work requirements for medically frail patients and their caregivers. Willie Underwood III, M.D., a Buffalo urologic surgeon, was sworn in as the AMA's 181st president, and Atlanta internist Sandra Adamson Fryhofer, M.D., was elected president-elect.

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