Biden Cracks Down on Prior Authorization — But There Are Limits
More than a year after it was initially proposed, the Biden administration announced a final rule yesterday that will change how insurers in federal programs such as Medicare Advantage use prior authorization — a long-standing system that prevents many patients from accessing doctor-recommended care. “When a doctor says a patient needs a procedure, it is […]
What Would a Nikki Haley Presidency Look Like for Health Care?
Former South Carolina Gov. Nikki Haley’s tenure in the Palmetto State — which overlapped with several tumultuous years of health care reform — and her recent comments offer clues to how her presidency might affect national health care policy.
Will CMS Crack Down on Prior Authorization?
There’s the Idaho doctor whose infant daughter developed a brain tumor. A woman in Southern California who waited months for an MRI before dying in the hospital. And a North Carolina patient who has trigeminal neuralgia — a condition so painful it’s commonly called the “suicide disease.” They all have something in common, aside from […]
Woman Petitions Health Insurer After Company Approves — Then Rejects — Her Infusions
Even people with good insurance aren’t guaranteed affordable care, as this KFF Health News follow-up to one patient’s saga shows.
Cancer Patients Face Frightening Delays in Treatment Approvals
Delaying cancer treatment can be deadly — which makes the roadblock-riddled process that health insurers use to approve or deny care particularly daunting for oncology patients.
Being Black and Pregnant in the Deep South Can Be a Dangerous Combination
Being Black has always been dangerous for pregnant women and infants in the South. And researchers say things are continuing to move in the wrong direction.
Doctors and Patients Try to Shame Insurers Online to Reverse Prior Authorization Denials
Prior authorization is a common tool used by health insurers for many tests, procedures, and prescriptions. Frustrated by the process, patients and doctors have turned to social media to publicly shame insurance companies and elevate their denials for further review.
New Charleston Museum Nods to Historical Roots of US Health Disparities
The $120 million International African American Museum that opened this week in Charleston, South Carolina, allows visitors to step back in history at Gadsden’s Wharf, where tens of thousands of enslaved Africans arrived in America, the genesis of generations of health disparities.
Burnout Threatens Primary Care Workforce and Doctors’ Mental Health
Burnout is a widespread problem in the health care industry. Although the pandemic made things worse, burnout among doctors is a long-standing concern that health systems have become more focused on as they try to stop doctors from quitting or retiring early.
A Striking Gap Between Deaths of Black and White Babies Plagues the South
Infant mortality rates across the South are by far the worst in the U.S. A look at South Carolina — where multimillion-dollar programs aimed at improving rates over the past 10 years have failed to move the needle — drives home the challenge of finding solutions, especially in rural communities.
How a 2019 Florida Law Catalyzed a Hospital-Building Boom
In Wesley Chapel, Fla., near Tampa, residents will soon have three general hospitals within a five-minute drive. The new construction is part of a hospital-building boom across Florida unleashed almost four years ago, when the state dropped a requirement that companies obtain government approval to open new hospitals.
Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients
The federal government wants to change the way health insurers use prior authorization — the requirement that patients get permission before undergoing treatment. Designed to prevent doctors from deploying expensive, ineffectual procedures, prior authorization has become a confusing maze that denies or delays care, burdens physicians with paperwork, and perpetuates racial disparities. New rules may not be enough to solve the problems.
Hospitals’ Use of Volunteer Staff Runs Risk of Skirting Labor Laws, Experts Say
Hospitals using volunteers is commonplace. But some labor experts argue that deploying unpaid workers to do work that benefits the organization’s bottom line lets for-profit hospitals skirt federal labor laws, deprives employees of work, and potentially exploits the volunteers.
Public Health Agencies Try to Restore Trust as They Fight Misinformation
As public health departments work on improving their message, the skepticism and mistrust often reserved for covid-19 vaccines now threaten other public health priorities, including flu shots and childhood vaccines.
Mass Shootings Reopen the Debate Over Whether Crime Scene Photos Prompt Change or Trauma
After almost every mass shooting, a debate is renewed over whether to publish the photos of the carnage the guns have inflicted.
Hurricane Ian Shows That Coastal Hospitals Aren’t Ready for Climate Change
Hundreds of medical centers along the Atlantic and Gulf coasts face serious risks from even relatively weak storms as climate change accelerates sea-level rise — not to mention big ones like Category 4 Hurricane Ian.
Wastewater Surveillance Has Become a Critical Covid Tracking Tool, but Funding Is Inconsistent
Dashboards that rely on positive covid test results reported to local health departments no longer paint a reliable picture of how covid is spreading in an area. Some experts say wastewater surveillance is the most accurate way to measure viral activity. Meanwhile, some wastewater labs face funding shortfalls.
The $18,000 Breast Biopsy: When Having Insurance Costs You a Bundle
An online calculator told a young woman that a procedure to rule out cancer would cost an uninsured person about $1,400. Instead, the hospital initially charged almost $18,000 and, with her high-deductible health insurance, she owed more than $5,000.
To Retain Nurses and Other Staffers, Hospitals Are Opening Child Care Centers
More than two years into the pandemic, parents face a child care crisis. That’s why some hospitals are considering starting child care centers to address recruitment and retention troubles.
A Nearly Century-Old Maternity Home for Teens in the South Makes Plans for Expansion
Homes for pregnant girls may seem like a vestige of the past. But they still exist and, in light of the Supreme Court’s recent ruling on abortion, may become more necessary.
