EBRI data show employer plans pay hospital outpatient departments about twice what physician offices receive for the same physician-administered drugs, and the commercial market has barely begun to address the gap.
News|Videos|January 13, 2025
How should primary care physicians navigate potential health care shifts under the Trump administration?
Author(s)Austin Littrell
Sheila P. Burke, chair, Government Relations and Public Policy Group, Baker Donelson Law Firm, advises primary care physicians on how to best navigate potential health care shifts under the Trump administration.
Advertisement
Later this month,
Advertisement
Related to this article
MGMA's government affairs staff walked through the fee schedule, value-based care, prior authorization, Medicaid and the year-end fight in Congress.
Current quality programs measure organizations and claims after the fact, but the next generation of measurement focuses on the everyday clinical decisions that drive unnecessary spending.
From a same-day payment cut to AI-run prior authorization in traditional Medicare, MGMA's government affairs team laid out what Washington has in store for physicians next year.
The American Medical Association and five specialty societies say casting AI as smarter than physicians diminishes their expertise, a day after the health secretary praised AI second opinions.
MGMA members described capping Medicare Advantage contracts and favoring commercial patients, while one Texas practice leader reluctantly called Medicare her best payer.
At an MGMA Government Affairs town hall, attendees raised extrapolated audits, employer plans beyond state reach and denials with no reason codes.
A fallback version would make insurers prove upcoding, notify physicians and limit downcoding to 90 days.
Advertisement
Advertisement
Trending on Medical Economics
1
GLP-1 users report more nail detachment, hair loss than nonusers, study finds
2
Six physician groups push back on claims that AI is better informed than doctors
3
The HIPAA and malpractice risks physicians take on with AI tools
4
DO women physicians become majority in primary care as workforce grows, AOA says
5