News & Information
Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers
Written by Editor   
Tuesday, March 05, 2019 05:58 PM

Despite epidemic rates of addiction and death from prescription opioids in the United States, suggesting the importance of providing alternatives to opioids in the treatment of pain, little is known regarding how payers’ coverage policies may facilitate or impede access to such treatments.

To examine coverage policies for 5 nonpharmacologic approaches commonly used to treat acute or chronic low back pain among commercial and Medicare Advantage insurance plans, plus an additional 6 treatments among Medicaid plans, A cross-sectional study was conducted of 15 commercial, 15 Medicaid, and 15 Medicare Advantage health plans for the 2017 calendar year in 16 states representing more than half of the US population. 

Medical necessity and coverage status for the treatments examined, as well as the use of utilization management tools and cost-sharing magnitude and structure.

Commercial and Medicare insurers consistently regarded physical and occupational therapy as medically necessary, but policies varied for other 00therapies examined.

Payers most commonly covered

  • physical therapy (98% [44 of 45 plans]),
  • occupational therapy (96% [43 of 45 plans]), and
  • chiropractic care (89% [40 of 45 plans]),

while transcutaneous electrical nerve stimulation (67% [10 of 15 plans]) and steroid injections (60% [9 of 15 plans]) were the most commonly covered among the therapies examined for Medicaid plans only.

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Improper Medicare Payments Lowest in Nearly a Decade
Written by Editor   
Tuesday, March 05, 2019 05:55 PM

More targeted enforcement actions by the CMS has led to the lowest improper payment rate for Medicare in nearly a decade, according to new federal data.  The CMS doled out an estimated $31 billion in improper payments in fiscal 2018, which is around 8.12% of all claims paid during that period. That's down from $36.2 billion or 9.51% of Medicare claims in fiscal 2017.

Improper payments include fraudulent claims, payments distributed to the wrong recipient or for the wrong amount, payments with insufficient documentation, and those when the recipient uses the funds improperly.

The CMS calculations include all claims incorrectly paid between July 1, 2016, and June 30, 2017. This is the lowest rate of improper payments for Medicare fee-for-service since 2010 and the second time since 2013 that the rate fell below 10%.

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Trump Administration: Ease Scope of Practice Laws
Written by Editor   
Tuesday, March 05, 2019 05:53 PM

Easing scope-of-practice laws and streamlining graduate medical education (GME) funding would make U.S. healthcare more competitive and efficient.

"Reduced competition among clinicians leads to higher prices for healthcare services, and reduces choice... Government policies have reduced competition by restricting the available supply of providers and restricting the range of services they offer,” said a senior administration official.

Although scope-of-practice (SOP) laws may be justified in cases where there is substantial risk of consumer harm, "Oftentimes, too, SOP restrictions limit provider entry and ability to practice in ways that do not address demonstrable or substantial risks to consumer health and safety," according to the report. "When this happens, these undue restrictions are likely to reduce healthcare competition and harm consumers -- including patients, and taxpayers more generally."

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Nearly a Quarter of Rural Hospitals are on the Brink of Closure
Written by Editor   
Tuesday, March 05, 2019 05:49 PM

More than a fifth of the nation’s rural hospitals are near insolvency, according to a new report.  Twenty-one percent of rural hospitals are at high risk of closing, according to Navigant's analysis of CMS data on 2,045 rural hospitals. That equates to 430 hospitals across 43 states that employ about 150,000 people and generate about $21.2 billion in total patient revenue a year

Hospitals are often the economic drivers of rural communities. Per capita income falls 4% and the unemployment rate rises 1.6 percentage points when a hospital closes, a related study found. Ninety-seven rural hospitals have closed since 2010, according to the University of North Carolina Cecil G. Sheps Center for Health Services Research.

As rural populations decline, inpatient admissions fall, more beds sit vacant, and the number of people covered by government-sponsored plans rises, these communities are left to grapple with the ramifications of losing a hospital.  A loss of acute-care beds and ultimately hospitals is inevitable, experts said.

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Cannabis Use in Adolescence and the Risk of Depression, Anxiety, and Suicidality in Young Adulthood
Written by Editor   
Tuesday, March 05, 2019 05:46 PM

Is adolescent cannabis consumption associated with risk of depression, anxiety, and suicidality in young adulthood?  In this systematic review and meta-analysis of 11 studies and 23, 317 individuals, adolescent cannabis consumption was associated with increased risk of developing depression and suicidal behavior later in life, even in the absence of a premorbid condition. There was no association with anxiety.

Preadolescents and adolescents should avoid using cannabis as use is associated with a significant increased risk of developing depression or suicidality in young adulthood; these findings should inform public health policy and governments to apply preventive strategies to reduce the use of cannabis among youth.

Cannabis is the most commonly used drug of abuse by adolescents in the world. While the impact of adolescent cannabis use on the development of psychosis has been investigated in depth, little is known about the impact of cannabis use on mood and suicidality in young adulthood.

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