State’s ACA marketplace issuers deny 13% of claims on average

June 1, 2023

According to data published by the Kaiser Family Foundation earlier this year, HealthCare.gov issuers in Florida denied an average of 13.1% of in-network claims in 2021 — below the national average of 17%, but still substantial. Denial rates and the reasons for claim denials also varied significantly by issuer. As FMA Director of Healthcare Policy and Innovation Jarrod Fowler concludes in a new article, “The findings of this report appear to indicate that greater oversight of claim denials is warranted.”

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Reflecting on a decade of medical discovery

June 1, 2023

Over the past 10 years, researchers at the AdventHealth Translational Research Institute (TRI) have tackled some of today’s biggest health problems, conducting more than 200 studies and producing 350-plus peer-reviewed published works. In a special essay, AdventHealth Senior Vice President and Chief Scientific Officer Steven R. Smith, MD, shares highlights from TRI’s decade of medical discovery, including groundbreaking studies that are currently underway.

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More federal guidance on the end of the Public Health Emergency

May 18, 2023

With the COVID-19 Public Health Emergency’s (PHE) expiration last Thursday, May 11, physicians should familiarize themselves with the PHE-related flexibilities that are permanent, those that will remain in place through Dec. 31, 2024, due to the omnibus bill passed last year, and the flexibilities that ended immediately with the PHE’s expiration.

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A physician-backed effort to support high-quality nurses

May 11, 2023

May 6-12 is National Nurses Week. In this opinion piece, Neil Finkler, MD, Chief Clinical Officer for AdventHealth’s Central Florida Division, writes about an effort to improve the overall work experience for AdventHealth’s nurses, and how his physician colleagues are supporting it.

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Good news for Florida physicians in the state budget

May 4, 2023

As the 2023 Legislative Session comes to a close, your Florida Medical Association has taken tremendous strides in improving the practice of medicine through the state budget process. It is through these accomplishments that the FMA is working to increase physician pay for those treating Florida’s most vulnerable patients; create new residency slots; and alleviate the medical student loan debt burden.

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Important MIPS update for performance year 2023

April 14, 2023

With the COVID-19 pandemic continuing to affect physicians and the Public Health Emergency not set to expire until May, the Centers for Medicare & Medicaid Services (CMS) recognizes that many medical practices will not be able to participate in MIPS. Therefore, this spring, CMS will open an application that physicians can submit to apply for a MIPS Extreme and Uncontrollable Circumstances waiver. If approved, this waiver will allow physicians to reweight one or more MIPS performance categories due to the COVID-19 PHE.

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AdventHealth receives Healthcare Innovation of the Year Award

April 14, 2023

DNV, one of the nation’s fastest-growing accrediting bodies, presented AdventHealth with its Healthcare Innovation of the Year Award during the 10th annual DNV Healthcare Symposium in Louisville, Ky. AdventHealth is the first healthcare system in the world to develop and implement a groundbreaking virtual MRI program that improves patient access, imaging quality and patient satisfaction.

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Insurers reduce prior authorizations as ‘clawbacks’ rise

April 6, 2023

According to recent reports, UnitedHealthcare plans to eliminate about 20% of its prior authorization requirements while Cigna claims to have done so for nearly 500 services since 2020. Meanwhile, insurance company “clawbacks” of provider payments reached a record high last year.

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Simplifying tobacco cessation intervention

April 6, 2023

Research has shown that even a brief intervention by a physician can make the difference in a patient’s success when attempting to quit tobacco products. However, time windows during patient office visits can be tight, leaving little room for those conversations.

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The FMA’s Policy on Artificial Intelligence

Mar. 30, 2023

With advancements in artificial intelligence (AI) constantly appearing in the news, some of you might be wondering what the FMA’s policy is on this increasingly important matter.

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Call for FMA reference committee nominations

Mar. 15, 2023

County and specialty medical societies are invited to nominate eligible physicians to serve on the FMA’s reference committees. The deadline for nominations is Friday, May 12.

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How to talk about Medicare payment reform

Mar. 15, 2023

As the FMA continues tackling Medicare payment reform, physicians can use our new fact sheet as a guide for discussing this issue with policymakers.

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FMA Joins 133 Organizations in Calling for Higher Medicare Payment Updates

Mar. 15, 2023

The Medicare Payment Advisory Commission (MedPAC), a body that advises Congress on Medicare payment issues, recently called for providing a 1.45% Medicare payment update for physicians in 2024. This amount is equal to half of the Medicare Economic Index (MEI), a measure of practice cost inflation.

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Surfacing the Inventor in All of Us

Mar. 15, 2023

Typically, the burden of solving medical problems lies with universities, government-funded institutions, or medical and pharmaceutical companies. Despite the time and effort these well-funded entities have dedicated to solving medical challenges, there continues to be a growing list of important unsolved medical problems.

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Capital Medical Society announces 2023 honorees: Andrea Friall, MD

Mar. 9, 2023

The FMA congratulates member Andrea Friall, MD who has been selected to receive the Capital Medical Society’s Thomas L. Hicks, MD Outstanding Physician Award.

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Are you prepared for the end of the Public Health Emergency?

Mar. 2, 2023

The COVID-19 Public Health Emergency (PHE) will expire at the end of the day on Thursday, May 11. With this transition quickly approaching, the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services have released more guidance on PHE-related flexibilities for physicians and other healthcare providers.

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The state of prior authorization, by the numbers

Feb. 16, 2023

The Kaiser Family Foundation’s recent analysis of 35 million prior authorization requests submitted to Medicare Advantage (MA) plans in 2021 includes this noteworthy observation: Though the rate of prior authorization request denials varied significantly among MA organizations, in most cases, the vast majority of denials that were appealed ended up being overturned.

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AdventHealth research contributes to approval of groundbreaking diabetes treatment

Feb. 16, 2023

After nearly 10 years as part of the TrialNet studies, physicians at AdventHealth Central Florida Division are administering the world’s first treatment to delay the onset of Type 1 diabetes (T1D). This treatment is now approved by the U.S. Food and Drug Administration (FDA) and available to patients in Central Florida, giving hope that T1D will one day be completely curable.

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Medicare enhances risk-adjustment audits

Feb. 2, 2023

On Jan. 30, CMS announced that it will seek to crack down on Medicare Advantage plans through changes to the risk adjustment data validation (RADV) program in a newly proposed rule. The purpose of the RADV program is to ensure that Medicare Advantage programs are receiving proper reimbursement for patients, based on the medical diagnoses that are attributed to those patients via medical documentation.

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What will the end of the Public Health Emergency mean to physicians?

Feb. 2, 2023

On Jan. 30, President Biden announced that the COVID-19 Public Health Emergency (PHE) will end on May 11. With this change looming on the horizon, it would be helpful for physicians to familiarize themselves with which flexibilities following the end of the PHE will be permanent, which will remain in place through Dec. 31, 2024, due to the passage of the omnibus bill passed last year, and which will expire immediately following the expiration of the PHE.

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Physician loan reimbursement assistance program launches Feb. 1

Jan. 25, 2023

Great news for physicians: On Feb. 1, the state Department of Health will launch the Florida Reimbursement Assistance for Medical Education (FRAME) Program to assist eligible healthcare practitioners with the repayment of medical education student loans. The FMA secured an annual appropriation of nearly $6.6 million for the program during last year’s Legislative Session, and eligible physicians and residents will be able to apply for up to $20,000 per year to reimburse medical educational expenses.

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FMA member receives national lifestyle medicine award

Jan. 19, 2023

The American College of Lifestyle Medicine (ACLM) presented FMA member George Guthrie, MD, with the 2022 President’s Award in November for his exceptional dedication to the growing field of lifestyle medicine. Dr. Guthrie, a family medicine physician with AdventHealth’s academic practice in Winter Park, has a special interest in lifestyle management for patients with chronic Type 2 diabetes, hypertension, obesity, and coronary heart disease.

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Payment reform and Florida’s physician workforce

Jan. 19, 2023

Where does physician payment reform stand at the federal level, and how are demographic shifts shaping Florida’s physician workforce? In his latest update, FMA Director of Healthcare Policy and Innovation Jarrod Fowler, MHA, summarizes the ongoing effort to make the Medicare physician payment system sustainable and notable takeaways from the Florida Department of Health’s new Physician Workforce Report.

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The future of telehealth flexibilities

Updated Jan. 12, 2023 | Originally published Dec. 1, 2022

Throughout the pandemic, physicians have widely embraced telehealth flexibilities granted under the COVID-19 Public Health Emergency to deliver telehealth services to their patients. These flexibilities were extended through 2024 under recently passed legislation.

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Governor unveils prescription drug reform legislation

Jan. 12, 2023

Today, Gov. Ron DeSantis unveiled a legislative proposal to reign in unchecked Pharmacy Benefit Managers (PBMs) and drive transparency among prescription drug prices influenced by the pharmaceutical industry. This proposal furthers the administration’s efforts to lower prescription drug prices and assist Floridians in making more informed health care decisions.

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