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|Slideshows|July 16, 2024
What JD Vance thinks about health care
Author(s)Todd Shryock
A look at JD Vance's congressional record on health care
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JD Vance, the junior senator from Ohio, has been chose by Donald
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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.
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