Private payers profit by delaying medical claims
Editor's Note Private payers initially deny reimbursement on 15% of claims, only to later approve more than half of those initial denials, according to a national survey of healthcare institutions published March 21 by Premiere, Inc. Additionally, the denied claims on average tend to be more prevalent for higher-cost treatments…
Study: Postoperative hospital readmissions higher for older Americans
Editor's Note Older Americans are at heightened risk for both short-term and long-term hospital readmission following major surgery, according to a study from Yale University published February 28 in Jama Network Open. Readmission places a major financial strain on health systems, researchers write, pointing out that the total cost…
Lack of primary care physicians tied to emergency surgeries
Editor's Note Research shows that Americans who live in areas with a limited number of primary care doctors and nurse practitioners are at a greater risk for emergency surgeries and complications. The findings were published March 4 in the journal Health Affairs. For the study, researchers looked at Medicare patient…
Medicare households have double the healthcare spending burden
Editor's Note The healthcare spending burden of Medicare households was double that of non-Medicare households in 2022, according to an analysis published by KFF (Kaiser Family Foundation) on March 14. Using data from the Consumer Expenditure Survey, KFF found that average health-related expenses made up 13.6% of Medicare households’ total…
Study: Nurses offer untapped potential to assess patient discharge readiness
Editor's Note Although few strategies for reducing readmission rates leverage nurse input, nurses are well-placed to identify patients most at risk, according to a study published in the March issue of the journal Medical Care. The authors note that older Medicare beneficiaries with multiple chronic conditions (MCCs) continue to experience…
Study examines high emergency department use by transgender Medicare patients
Editor's Note A study showing greater likelihood for transgender (TGD) Medicare patients to use the emergency department highlights the need to train staff in transgender-inclusive care, the authors argue. Conducted by the Brown University School of Public Health, the study was published February 13 in JAMA Internal Medicine. As reported…
Study on cholecystectomy robotic surgery raises safety concerns
Editor's Note Despite the increasing prevalence of robotic-assisted surgery, recent data on cholecystectomy results indicates minimally invasive laparoscopic methods could be a safer option. Published in JAMA Surgery on September 20, the nationally representative study of Medicare beneficiary cholecystectomy patients showed a higher rate of bile duct injury (0.7%) for…
Follow-up primary care visits reduce readmission rates for EGS patients
Editor's Note A recent study of Medicare beneficiaries found that patients hospitalized for an emergency general surgery (EGS) condition who had primary care follow-up within 30 days of discharge had much lower readmission rates. The investigative findings were published on September 27 in JAMA Surgery. Some highlights include: Patients who…
Problems with prior authorization, utilizing health insurance coverage are prevalent, survey finds
Editor's Note This KFF survey from June 2023 found that some six in 10 adults with health insurance have experienced problems when trying to use their insurance, KFF Health News September 29 reports. The problems included denied claims, network adequacy issues, and preauthorization delays and denials. According to the survey,…
New CMS rule focuses on postop opioids in outpatient settings
Editor's Note The Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, which is set to take effect in 2025, will set up a separate Centers for Medicare and Medicaid Services (CMS) payment for certain nonopioid pain management techniques in outpatient and ambulatory surgery center (ASC) settings, the September 12 Becker’s…
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