A recent AMA analysis reveals that 95% of U.S. metropolitan statistical areas have highly concentrated commercial health insurance markets, a trend persisting over the past decade. In 89% of these markets, a single insurer commands at least 30% market share, with Blue Cross Blue Shield leading in 83% of MSAs. The study also highlights that 97% of Medicare Advantage markets are similarly concentrated, with UnitedHealth holding the largest national share.
The American Medical Association (AMA) has called for stricter oversight of nonprofit hospitals' charity care policies to ensure financial assistance is accessible to eligible patients. The AMA advocates for standardized eligibility criteria, mandatory patient screening for charity care, and penalties for noncompliance, highlighting that many hospitals provide less community benefit than they receive in tax breaks. Additionally, the AMA supports measures to prevent insurers from denying payment for pre-authorized medical services.
The Centers for Medicare and Medicaid Services has finalized a 2.8% payment cut for physicians in the 2025 Medicare Physician Fee Schedule, prompting swift protests from medical groups. They argue that this cut, alongside rising costs, threatens patient care and physician practices, calling for immediate legislative action to avert the reduction. A bipartisan bill aims to eliminate the cut and provide a 4.7% payment update, but time is running out for Congress to act before the cuts take effect on January 1, 2025.
A bipartisan bill introduced in the House aims to prevent a 2.8% Medicare payment cut set for January and provide a 4.7% pay increase for physicians in 2025. The American Medical Association emphasizes the urgent need for action, citing a 29% decline in Medicare reimbursement since 2001, which threatens the viability of medical practices.
The American Medical Association and the Illinois State Medical Society have filed a lawsuit against MultiPlan, alleging involvement in a price-fixing conspiracy with health insurers that has led to unfairly low payments for out-of-network services. This scheme, reportedly in operation since 2015, has harmed both patients and physicians, forcing many medical practices to close or limit services. The lawsuit seeks to reform the out-of-network payment systems reliant on MultiPlan's practices, which have significantly increased the company's revenues while suppressing physician payments.
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