Related Stories

Appropriate Use of Time? Medicare Rules for Advanced Imaging Orders Pose Prior-Auth Burdens - 04/09/2020

An effective way to cut down on overuse of potentially harmful imaging, or a prior authorization-esque burden on physicians who order needed tests? Texas physicians see Medicare’s “appropriate use” system for advanced imaging both ways. As of Jan. 1, physicians ordering advanced imaging tests for Medicare patients must consult an electronic portal, which evaluates whether the test meets Medicare’s own “appropriate use criteria” for whether a test should be ordered. Then when the claim is filed, physicians must document that they checked the system and its determination.  


Plans Should Inform Patients of Network Status When Requiring PA - 03/25/2019

When a patient is preauthorized to receive a health care service scheduled at a facility, the health plan should use the information submitted on the standardized prior authorization form to inform the patient of the network status of any physicians or health care providers who may be involved in the preauthorized health care. It also should be used to educate the patient on what level of coverage the health plan will provide and what the patient’s financial responsibility will be to all physicians and providers.


Medicine to Feds: Back Off Prior Authorization Requirements - 03/07/2019

The Texas Medical Association, American Medical Association, and a host of other medical societies are trying to stop onerous, care-impeding prior authorization requirements from overrunning Medicare Advantage plans.


Cancer Incidence Among Texas Publicly Funded Substance Abuse Treatment Clients - 10/08/2018

In this study, the authors examine the incidence of cancer among a large cohort of patients receiving Texas Department of State Health Services publicly funded substance abuse treatment services between 2005 and 2009. We hypothesized that substance abuse patients would have an increased incidence of cancer, especially cancers associated with alcohol misuse, tobacco use, and opiate dependence. We compared cancer incidence among 119,237 substance abuse patients with those in the Texas general population as reported to the Texas Cancer Registry. The cohort was 60% male; and 50% white, 30% Hispanic, and 20% black. Mean age at the start of follow-up was 47.6 years (SD, 10.5 years), with mean follow-up time of 2.4 years (SD, 1.5 years). Primary drug dependency was 30% alcohol; 25% cocaine; 15% opiate; 13% amphetamine or methamphetamine; and 17% marijuana or other drugs. Almost 75% of the patients used tobacco regularly. The overall age-adjusted incidence rate was lower for substance abusers ...


Humana Peer-to-Peer Review Changing for Medicare Advantage Plans - 10/05/2018

Effective Aug. 1, Humana Medicare Advantage health plans will no longer offer peer to peer reviews after a medical necessity denial. Instead, the company will offer to schedule a peer-to-peer review before Humana issues the denial


TMA Delegates Push Back Against Preauth - 05/30/2018

The Texas Medical Association House of Delegates worked to recover the time and authority that insurance authorization and preauthorization requirements have increasingly taken from the state’s physicians.


U.S. Physicians Call Prior Authorizations An Overwhelming Burden - 04/12/2018

A nationwide survey released this week by the American Medical Association documents the growing, negative effects insurance companies’ prior authorization demands have on patients’ health and physicians’ time.


Top Physician Experts to Convene First-Ever Maternal Health Congress to Address Maternal Deaths Crisis - 03/20/2018

More than 70 top obstetrician-gynecologists, family physicians, and other physicians and health experts from across Texas will convene the state’s first-ever Texas Medical Association (TMA) Maternal Health Congress in Austin on Saturday. Their goal is to address the alarming rate of women dying after childbirth and seek solutions to the complex issue.


Facing More Hoops - 10/27/2017

Opioid abuse has killed tens of thousands of Americans in recent years, prompting health plans to adjust their prescription drug policies, including changing formularies and prior-authorization processes.


Patients With a Substance Use Disorder Need Treatment — Not Stigma - 05/24/2016

Commentary — May 2016 By the AMA Task Force to Reduce Opioid Abuse Junkie, stoner, crackhead — We've all heard the terms used to describe those who struggle with drug addiction. These terms are dismissive and disdainful; they reflect a moral judgment that is a relic of a bygone era. We need to change the national discussion. Put simply, those with substance use disorders are our patients who need treatment. May is Mental Health Month, a good time to remember this important fact and to ensure we carry the message throughout the year.  Scientific progress has helped us understand that addiction — also referred to as substance use disorder — is a chronic disease of the brain. It is a disease that can be treated successfully. No one chooses to develop this disease. Instead, a combination of genetic predisposition and environmental stimulus — analogous to other chronic diseases like diabetes and hypertension — can result in physical changes to the brain's circuitry, which lead to tole...