TL;DR: the answer is no. Health insurance for profit is incompatible with healthcare. The former focuses on making money for the company bigwigs and shareholders, while the latter focuses on the life of the patient. The more it costs to improve the health or save the life of the insured patient, the more for-profit insurer’s interests oppose those of their insureds. For-profit healthcare should be outlawed.
Medicare spending grew 5.9% to $944.3 billion in 2022, or 21 percent of total NHE. Medicaid spending grew 9.6% to $805.7 billion in 2022, or 18 percent of total NHE. Private health insurance spending grew 5.9% to $1,289.8 billion in 2022, or 29 percent of total NHE.Sep 10, 2024
AMA and CMS have failed patients by allowing ….no, promoting due to conflicts of interest…consolidation, complexity, and corruption for profit. The system needs to be exposed and simplified, returning to payment for value, just as was done with Elon Musk’s Rockets.
"In 2018, the AMA, the American Hospital Association, and the American Pharmacists Association met with the American Health Insurance Plans group, the Medical Group Management Association, and representatives of Blue Cross/Blue Shield Association to discuss streamlining and reforming the PA process. This led to a Consensus Statement on Improving the Prior Authorization Process. The statement recommended developing criteria for exempting some providers; using data analytics and up-to-date clinical criteria to reduce the number of drugs and procedures requiring PA, especially when nearly always approved; using automation to improve the efficiency and transparency of the PA process; and implementing procedures to protect patients during transitions.
A 2020 AMA follow-up survey of 1000 physicians found that after three years little or no progress had been made in achieving reforms. Most troubling was the fact that not only were PA requirements not updated and reduced, but 83% reported that PA requirements for both drugs and medical services had increased over the follow-up period with 38-40% reporting that PA requirements “increased significantly”.
Also troubling was the finding that 87% of physicians held that PA continued to “sometimes”, “often”, or “always” interfere with the continuity of care.
In addition, only 11% reported contracting with a plan that provided some exemptions and 58-68% complained of continuing lack of transparency including difficulty accessing PA requirements and updates, a source of many application errors. Less than 24% were using electronic portals for PA processing with fax and phone continuing as the primary mode of communication.
AMA President, Susan Bailey MD, issued a press release after the survey. “…the sad fact is little progress has been made on the reform goals.” She endorsed a bi-partisan federal bill HR 3173 that aims “to rein in prior authorization practices that adversely affect patient health.” That legislation is pending.
The real question should be quote Why in hell should insurance companies be the ones to authorize any medical procedure?". Why should the fox be guarding the hen house?
TL;DR: the answer is no. Health insurance for profit is incompatible with healthcare. The former focuses on making money for the company bigwigs and shareholders, while the latter focuses on the life of the patient. The more it costs to improve the health or save the life of the insured patient, the more for-profit insurer’s interests oppose those of their insureds. For-profit healthcare should be outlawed.
Medicare spending grew 5.9% to $944.3 billion in 2022, or 21 percent of total NHE. Medicaid spending grew 9.6% to $805.7 billion in 2022, or 18 percent of total NHE. Private health insurance spending grew 5.9% to $1,289.8 billion in 2022, or 29 percent of total NHE.Sep 10, 2024
https://www.cms.gov › data-research
NHE Fact Sheet - CMS
AMA and CMS have failed patients by allowing ….no, promoting due to conflicts of interest…consolidation, complexity, and corruption for profit. The system needs to be exposed and simplified, returning to payment for value, just as was done with Elon Musk’s Rockets.
Thanks for the excellent summary. You may want to include information about how physicians (and the AMA) see Prior Authorization. Below is an excerpt from a brief I wrote a few years back when NYC was trying to force municipal workers onto an MA plan. (The source material is at https://www.ama-assn.org/system/files/2021-04/prior-authorization-survey.pdf (Reform progress) https://www.ama-assn.org/system/files/2021-05/prior-authorization-reform-progress-update.pdf
https://www.ama-assn.org/press-center/press-releases/insurer-inaction-prior-authorization-reform-requires-federal-response)
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"In 2018, the AMA, the American Hospital Association, and the American Pharmacists Association met with the American Health Insurance Plans group, the Medical Group Management Association, and representatives of Blue Cross/Blue Shield Association to discuss streamlining and reforming the PA process. This led to a Consensus Statement on Improving the Prior Authorization Process. The statement recommended developing criteria for exempting some providers; using data analytics and up-to-date clinical criteria to reduce the number of drugs and procedures requiring PA, especially when nearly always approved; using automation to improve the efficiency and transparency of the PA process; and implementing procedures to protect patients during transitions.
A 2020 AMA follow-up survey of 1000 physicians found that after three years little or no progress had been made in achieving reforms. Most troubling was the fact that not only were PA requirements not updated and reduced, but 83% reported that PA requirements for both drugs and medical services had increased over the follow-up period with 38-40% reporting that PA requirements “increased significantly”.
Also troubling was the finding that 87% of physicians held that PA continued to “sometimes”, “often”, or “always” interfere with the continuity of care.
In addition, only 11% reported contracting with a plan that provided some exemptions and 58-68% complained of continuing lack of transparency including difficulty accessing PA requirements and updates, a source of many application errors. Less than 24% were using electronic portals for PA processing with fax and phone continuing as the primary mode of communication.
AMA President, Susan Bailey MD, issued a press release after the survey. “…the sad fact is little progress has been made on the reform goals.” She endorsed a bi-partisan federal bill HR 3173 that aims “to rein in prior authorization practices that adversely affect patient health.” That legislation is pending.
Thank you.
The real question should be quote Why in hell should insurance companies be the ones to authorize any medical procedure?". Why should the fox be guarding the hen house?
Exactly.
Medicare Advantage is a scam.