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What We’re Reading: Prior Authorization for Colonoscopies; Stalled Infant, Maternal Death Prevention; Hospital Police Forces
UnitedHealthcare will require most colonoscopies to have prior authorization; the World Health Organization says that progress in reducing maternal and infant deaths has halted; hospitals are creating their own police forces to address increasing violence against staff.
Change to United’s Colonoscopy Coverage Incites Frustration
Gastroenterologists learned in March that UnitedHealthcare plans to block many colonoscopies behind prior authorization starting on June 1, meaning that any United members seeking surveillance and diagnostic colonoscopies to detect cancer will need United’s approval first, or else have to pay out of pocket, reported STAT News. Doctors say that the prior authorization requirement will make it harder for patients to get endoscopic procedures, especially cancer diagnostic and surveillance procedures, done promptly. These procedures make up about 50% of those that gastroenterologists perform.
Infant and Maternal Death Reduction Has Stagnated, Says WHO
International progress on maternal and infant health is languishing, the World Health Organization (WHO) suggested in a report, according to The Washington Post. Agency officials mentioned “extraordinarily high” rates of preventable maternal deaths, stillbirths, and newborn deaths in a document released in May. Just in 2020, the agency reported that a combined 4.5 million deaths transpired among mothers and infants. To meet targets in areas including prenatal care, the presence of skilled health professionals at every birth, and postnatal care for newborns, the world would need to decrease maternal mortality by 11.6% annually this decade and continue reducing stillbirths and infant deaths.
Violence Against Staff Has Hospitals Creating Police Forces
This May, Georgia Governor Brian Kemp, a Republican, signed a law that increases criminal penalties for assaults against hospital workers and permits health care facilities in the state to make independent police forces, reported NPR. The law comes in response to a testimony of hospital violence, hospital lobbying, and data documenting an increase in violence against health care workers. In appointing the law, Georgia joined other states trying to reverse a rise in violence over the last few years through more rigid criminal penalties and boosted law enforcement.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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