Coding scrutiny, payment gaps and a push for price caps show up across Trilliant Health's annual look at where U.S. health care is headed.
News|Videos|February 22, 2024
On Capitol Hill: Rep. Larry Bucshon, MD, on reforming prior authorizations, part 1
Author(s)Richard Payerchin
A congressman discusses current health care issues in Washington, D.C.
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The “Improving Seniors’ Timely Access to Care Act” would reform the prior authorization process for Medicare Advantage plans. The act had widespread medical and political support in 2022 and still does, but a 2022 cost estimate – at more than $16.24 billion – by the Congressional Budget Office doomed it in the legislature. Rep. Larry Bucshon, MD (R-Indiana), explains.
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Trilliant Health's annual trends report traces primary care shortages, payment gaps and looming price caps to incentives no single stakeholder has reason to fix.
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.
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.
MGMA members described capping Medicare Advantage contracts and favoring commercial patients, while one Texas practice leader reluctantly called Medicare her best payer.
Start with a spreadsheet, add curiosity and communication, and make a real difference to practice income.
From AI scribes and coding habits to the claims payers quietly cut, these are the lessons physicians can take from four days of sessions and interviews at the Medical Group Management Association's centennial meeting.
It's not a patient problem, it's an operations problem, and large practices and health systems need to treat it that way.
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