July 18, 2024

July 18, 2024 Customer Newsletter

By Challenger Corporation · 2 minute read

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Prior Authorization Bad for Patient Care
PCPs Take On More Mental Health Duties
SCOTUS Limits Federal Power: How This Affects Healthcare

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Physicians Say Prior Authorization Leads to Bad Outcomes

While it’s no surprise that physicians believe prior authorization requirements from insurance companies lead to bad care (90%), the middle of the article reveals more interesting numbers. The average number of prior authorizations per week: 43. The percentage agreeing that prior authorization requests are routinely denied: 27%. Ineffective initial treatments due to prior authorization requirements: 68%. The insurer can generally cover themselves with “standard of care” and blame the physician for bad outcomes.

There are some 2026 requirements for tightening the timeframe for authorization response, requiring a denial cause from the insurer, and establishing requirements for electronic exchanges for EHRs and prior authorization.

Physicians Say Prior Authorization Leads to Bad Outcomes

AMA Survey Indicates Prior Authorization Wreaks Havoc on Patient Care - AMA

Primary Care Providers Take On More Mental Health Duties

Over half the population lives in areas with psychiatric care shortages. Medicaid’s low reimbursement rates restrict providers' willingness to accept it for payment, and private insurers use restrictive networks and other policies to circumvent the Mental Health Parity and Addiction Equity Act. Coupled with the difficulty caused by anosognosia, patients' lack of insight, and noncompliance with complex medication plans, this results in serious psychiatric problems that get dumped into EDs everywhere. This article discusses a plan to provide a more collaborative care environment between primary and behavioral health services.

Mental health is a major issue in the general health problems that will arise in healthcare systems in the future.

Primary Care Providers Take On More Mental Health Duties

The Supreme Court Just Limited Federal Power: Health Care Feels the Shockwaves

The Supreme Court didn’t limit federal power, it pushed some law-making out of the executive branch and back over to Congress. Congress will still pass laws delegating regulatory power to parts of the executive branch, but have to do it more deliberately, and keep the regulatory oversight clearly stated in law. A 1984 ruling by the Supreme Court allowed federal agencies to expand regulations for changing environments, this years ruling says the agencies have taken their self-definition too far.

What the ruling does mean is that a lot of executive branch regulations are about to get challenged in court, unless Congress steps in to define the laws more clearly. Which means Congress will actually have to vote and take responsibility, and unrestrained executive branch power will be reduced - which is overall probably a good thing.

That shift of responsibility from courts to Congress is not getting mentioned in a lot of the articles, and not getting the attention it deserves. Nor are any regulations getting thrown out. In the immediate aftermath of the ruling, though, everybody with a gripe against the CMS, FDA, and FTC (which appears to be everyone in health care) are probably rushing to court.

The Supreme Court Just Limited Federal Power. Health Care Is Feeling the Shockwaves. - KFF Health News

Supreme Court Overrules Chevron, Diminishing Healthcare Agencies - Fierce Healthcare

Chevron Runs out of Gas: The Road Ahead for Health Regulations Gets Cloudy After Loper Bright - Akin Gump Strauss Hauer & Feld LLP