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The Burden of Insurance Prior Authorization on Cancer Care: A Review of Evidence From Radiation Oncology.
Adv Radiat Oncol
January 2025
Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Purpose: Despite its high cost-effectiveness, radiation oncology faces the greatest prior authorization (PA) burden of any medical specialty. Insurance denials and resulting treatment delays have been documented across several treatment modalities, including stereotactic body radiation, intensity modulated radiation, and proton therapy. Although insurance companies suggest that PA is intended to control health care spending and ensure the implementation of evidence-based practice, the number of radiation treatment plans reviewed by the PA process that result in changes is quite low.
View Article and Find Full Text PDFEvaluating the impact of 2011 tort reform limiting noneconomic damages in North Carolina and Tennessee on testing, imaging, and procedure utilization.
Health Serv Res
December 2024
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Objective: To evaluate the impact of tort reform laws passed in 2011 capping noneconomic damages in North Carolina and Tennessee on rates and adjusted per user costs of tests, imaging, and procedures in the Medicare fee-for-service population.
Study Setting And Design: State-level synthetic difference-in-differences, adjusting for the percent of FFS Medicare beneficiaries in the state who were female, had ever been on Medicare Advantage, were eligible for Medicaid for at least 1 month of the year, and total state risk-adjusted, standardized per-capita costs. Analyses of North Carolina and Tennessee were performed separately.
Why do we need quality measures in emergency medicine?
J Am Coll Emerg Physicians Open
December 2024
Department of Emergency Medicine Stanford University Palo Alto California USA.
Quality measures increasingly influence the delivery and reimbursement of care provided in emergency departments. While emergency physicians are accustomed to using quality measures to improve care delivery, payors, including the Centers for Medicare and Medicaid Services (CMS), are increasingly adjusting reimbursement to measure performance as a means to bend the cost curve and improve the value of healthcare services. The American College of Emergency Physicians Quality and Patient Safety Committee presents this whitepaper to guide practicing emergency physicians through the policy context of implementing measures in emergency care and understanding its impact reimbursement.
View Article and Find Full Text PDFMOUD use among Hispanic clients increased post-ACA, yet differed by heritage and geographic location.
Drug Alcohol Depend
January 2025
Boston University Chobanian & Avedisian School of Medicine, Department of General Internal Medicine, United States; Grayken Center for Addiction Medicine at Boston Medical Center, United States. Electronic address:
Background: Overdose death rates for Hispanic people rose 2010-2022. Opioid overdose rates grew faster among Hispanic people than non-Hispanic White people ("White"). Medication for opioid use disorder (MOUD) is an effective but underutilized intervention for decreasing overdose risk.
View Article and Find Full Text PDFThe lasting impact of the ACA: how Medicaid expansion reduces outcome disparities in AYAs with leukemia and lymphoma.
Hematology Am Soc Hematol Educ Program
December 2024
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
The Affordable Care Act (ACA), fully implemented in 2014, introduced reforms to Medicaid and the Children's Health Insurance Program (CHIP), aiming to enhance health care access for vulnerable populations. Key provisions that can influence health outcomes in adolescents and young adults (AYAs) with blood cancers include Medicaid expansion, which covers adults with income less than or equal to 138% of the federal poverty level based on modified adjusted gross income (MAGI), streamlined eligibility and enrollment processes, CHIP and Medicaid integration, and dependent coverage reform. Non-MAGI eligibility pathways based on age, disability, or waiver programs provide alternative routes for Medicaid coverage.
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