DOJ task force, insurers target ASC barriers with parallel reforms
Editor's Note Federal regulators and major insurers are independently moving to ease long-standing burdens on ambulatory surgery centers (ASCs), potentially reshaping the regulatory and administrative landscape in which perioperative leaders operate. According to Ambulatory Surgery Center News June 23, ASC stakeholders are actively engaging with the new Anticompetitive Regulations Task…
Major insurers pledge prior authorization reform
Editor's Note Nearly 50 major US health insurers—including UnitedHealthcare, Aetna, Cigna, Elevance, and Humana—have pledged to reform prior authorization practices, with the goal of easing administrative burdens and improving access to care, according to a June 23 article in Healthcare Dive. As detailed in the article, the announcement came from…
Cardiology efficiency, orthopedic revenue surge as ASCs navigate growing complexity
Editor's Note HST Pathways’ most recent industry report, discussed on the Advancing Surgical Care Podcast by HST CEO David Thawley and Bill Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), offers insights into cardiology and orthopedic procedures done in ambulatory surgery centers (ASCs) in 2024, Ambulatory Surgery Center News…
Montana legislators' prior authorization reform push mirrors national trends
Editor's Note Montana legislators are moving to restrict health insurers’ use of prior authorization as frustration over the practice mounts nationwide, KFF News reported February 13. The outlet reports that two Democratic and Republican lawmakers have introduced or are drafting bills for the 2025 Montana Legislature to limit these insurer-mandated…
Cigna ties executive pay to patient experience
Editor's Note As part of a larger initiative to ease access to care, insurance giant Cigna is tying compensation for senior leadership directly to customer satisfaction. Modern Healthcare reported the news February 3. The shift is part of a multi-pronged approach that also includes overhauling prior authorization requirements and limiting…
Providers push back on insurance cost-cutting hurdles
Editor's Note Escalating administrative hurdles from insurers are heightening tensions between healthcare payers and providers who criticize the measures for threatening patient care, Modern Healthcare reported January 22. According to the article, policies attracting criticism include stringent prior authorization rules, claims denials, and new fees for appeals. For their part,…
GOP-controlled Senate to prioritize drug pricing, health agency reform
Editor's Note Republicans secured a 51-seat majority in the US Senate after victories in Ohio and West Virginia, promising a power shift that will see GOP leaders shaping decisions on pressing issues like drug pricing, public health agency reform, and rural healthcare. On November 6, STAT published an overview of…
Medicare Advantage insurers prioritize profits over patients, Senate reports
Editor's Note A Senate report reveals that Medicare Advantage insurers are increasingly prioritizing profits over patient care by ramping up the use of prior authorization to deny necessary services, particularly post-acute care, for older adults, Becker’s Hospital Review reported October 17. In May 2023, the Senate Permanent Subcommittee on Investigations…
Medicare policy on prior authorization falls short on shifting outpatient surgery trends
Editor's Note A Medicare policy introduced in 2020, which requires prior authorization for certain procedures done at hospital outpatient departments (HOPDs), has not significantly reduced the volume of surgical procedures being done at these facilities, reports a study by Michigan Medicine, University of Michigan, published on October 9. The policy,…
Physician survey illuminates negative impact of prior authorization
Editor's Note The American Medical Association (AMA) annual, nationwide prior authorization survey reveals that over 90% of physicians believe prior authorization negatively impacts patient clinical outcomes. “More telling,” AMA reported July 17, is the fact that 78% of physicians report that this process “sometimes or often” leads to patients abandoning…
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