GTS Financial Health, LLC

Private Equity's Influence on U.S. Healthcare: A Pressing Concern Requiring Immediate Attention


Guy T. Sullivan Jr • September 05, 2024

What It Means for You – A Patient & Provider's Perspective

As a patient, have you ever wondered what goes on behind the scenes to ensure you receive the best possible care? The Medical Group Management Association (MGMA) is a leading advocate for medical practices nationwide, and their 2024 agenda is a roadmap for a stronger, more patient-centered healthcare system. Here's what they're fighting for, and why it matters to you:


Fair Reimbursement for Your Doctors: MGMA is pushing for policies that ensure doctors and their practices receive fair payment for the care they provide. This isn't just about doctors' salaries; it's about making sure your practice has the resources to invest in new technology, hire top-notch staff, and ultimately deliver better care to you.


Cutting the Red Tape of Prior Authorizations: Tired of waiting for prior authorizations? So is MGMA. They're advocating for reducing unnecessary paperwork and delays, so you can get the care you need when you need it.


Prior Authorizations: A Growing Burden on Your Healthcare

This is a topic close to our hearts at GTS Financial Health LLC. We've seen firsthand how the prior authorization process can delay or even deny patients the care they need. A recent February 2024 report confirms what we've witnessed:

  • Overburdened Practices: Nearly 90% of medical practices find prior authorizations very or extremely burdensome, with most having to hire or redistribute staff just to handle the increasing requests.
  • Delays and Denials: A staggering 97% of practices report that their patients have experienced delays or denials for medically necessary care due to prior authorization requirements.
  • Top Challenges: Inconsistent payer policies, unnecessary authorizations for routine care, and delays in decision-making are the most common frustrations for medical providers.


It's disheartening to see insurance companies prioritize cost-saving measures over patients' well-being, often pushing for less effective treatments while raising premiums.


Moving Beyond Fee-for-Service: MGMA is championing value-based care models that reward doctors for keeping you healthy, not just for treating you when you're sick. This shift could mean more preventive care, better chronic disease management, and ultimately, a healthier you.


Quality Care, Not Just Quality Reports: Doctors spend too much time on paperwork and not enough time with patients. MGMA is working to streamline quality reporting so doctors can focus on what they do best – caring for you.


Protecting Your Surprise Medical Bills: The No Surprises Act was a major win for patients, but implementation is key. MGMA is working to ensure the law is applied fairly and that you're protected from unexpected medical costs.


Embracing Technology, Ethically: AI has incredible potential to improve healthcare, but it needs to be done right. MGMA is advocating for responsible development and use of AI, with your privacy and safety at the forefront.


What This Means for You:


MGMA's advocacy efforts aren't just about doctors and medical practices; they're about you, the patient. Their goal is a healthcare system that is financially sustainable, efficient, and focused on delivering the highest quality care possible. By supporting policies that empower doctors and their practices, MGMA is ultimately working to create a better healthcare experience for everyone.


We're Here to Help:


At GTS Financial Health LLC, we're committed to advocating for your patients and working with insurers to streamline the prior authorization process. Your patient’s health and well-being are our top priorities, and we'll continue to fight for your access to timely, necessary care.


Sources:

https://www.mgma.com/getkaiasset/dfb7f57e-ee7a-4528-b7a4-0374ed48bb54/MGMA%202024%20ADVOCACY%20AGENDA_FINAL.pdf?_gl=1*1rw0zib*_gcl_au*MjY4NjIzNzIyLjE3MTU3OTM0OTU.*_ga*MjAxMzY3NDUyMC4xNzE1NzkzNDk1*_ga_DT1SR7HF62*MTcxNTg2MjEwNC4zLjEuMTcxNTg2MjM2OC41Ni4wLjA.


https://www.mgma.com/getkaiasset/7caa3c7f-3e0e-443d-873d-b7194673752e/MGMA%202024%20Prior%20Authorization%20Issue%20Brief_FINAL.pdf?_gl=1*1feo1cp*_gcl_au*MjY4NjIzNzIyLjE3MTU3OTM0OTU.*_ga*MjAxMzY3NDUyMC4xNzE1NzkzNDk1*_ga_DT1SR7HF62*MTcxNTg2MjEwNC4zLjEuMTcxNTg2MjEzMC4zNC4wLjA.

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