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What We're Reading: Hospital Closures; Mixed Messages on PBMs; VA Wrongly Denies Sexual Trauma
Patients living in rural areas have fewer options for a hospital as closures continue at a rate of about 30 a year; the Trump administration is sending mixed messages about how it views pharmacy benefit managers (PBMs); thousands of veterans suffering from posttraumatic stress disorder may be left without benefits after the Department of Veterans Affairs (VA) improperly handled as many as 1300 sexual trauma claims.
Rate of Hospital Closures Expected to Pick Up
Patients living in rural areas have fewer options for a hospital as closures continue at a rate of about 30 a year. However, an analyst expects that the number of hospitals shutting down may actually increase in the next 1 year to 18 months, reported Bloomberg. As hospitals consolidate, payers are also increasingly pushing patients toward outpatient services, online providers, and retail clinics.
Trump Administration Gives Mixed Messages on PBMs
As part of his promise to lower prescription drug prices, President Donald Trump has targeted pharmacy benefit managers (PBMs), but some days his own administration seems to be interested in empowering PBMs. This mixed message has made it difficult for lobbyists and policy makers to determine the administration’s overall strategy, according to STAT. Even while Trump has decried PBMs, CMS’ new proposal to allow Medicare Advantage plans to negotiate drug prices using step therapy will most likely rely on PBMs.
The VA Improperly Denied Military Sexual Claims
Thousands of veterans suffering from posttraumatic stress disorder may be left without benefits after the Department of Veterans Affairs (VA) improperly handled as many as 1300 sexual trauma claims. According to USA Today, the employees vetting the claims were not trained properly, and the VA didn’t even order required medical exams in more than half the cases. Although the VA put special rules in place to vet claims of sexual assault, the VA stopped conducting audits of sexual trauma claims in 2015.
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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