UnitedHealthcare’s national prior authorization gold-card program went into effect on Oct. 1, offering reduced pre-certification requirements for providers who meet specific eligibility criteria. Providers must maintain a high prior authorization approval rate and be in-network with UnitedHealthcare plans to qualify. The program aims to streamline the approval process, though it has drawn criticism from the American Gastroenterological Association and American College of Gastroenterology. Some physicians are cautiously optimistic about its potential benefits for patients and providers.
Author: Abhay Panchal
The American Society of Anesthesiologists (ASA) filed a trademark complaint against the American Association of Nurse Anesthesiology (AANA) over the latter’s use of the term “anesthesiology,” claiming it could confuse patients. AANA argues that nurse anesthetists have a long history of safely administering anesthesia. The case reflects broader tensions around professional titles and scope of practice between physicians and nurse practitioners. The decision will be made by the Trademark Trial and Appeal Board but could escalate to federal court.
In this episode of the MGC podcast, Dr. Laurie Keefer discusses her work in brain-gut behavior therapies for GI conditions like Crohn’s disease, ulcerative colitis, IBS, and GERD. She highlights the resistance within the medical community toward nonpharmacological treatments and explores how she selects appropriate behavioral interventions for individual patients. As a key figure in the Rome Foundation and with over 250 peer-reviewed publications, Dr. Keefer shares insights on the growing role of psychological therapies in managing GI disorders.
GI Alliance, the largest U.S. network of gastroenterology practices, has partnered with Medtronic to implement the AI-powered GI Genius™ endoscopy module across its 400 locations. This technology improves polyp detection during colonoscopies, reducing missed polyps by up to 50%, which is critical in early colorectal cancer detection. This collaboration underscores GI Alliance’s commitment to integrating innovative AI solutions to enhance patient care and outcomes, especially in the fight against colorectal cancer.
A new study suggests that patients taking GLP-1 medications like Ozempic, Wegovy, Mounjaro, or Zepbound may have inadequate bowel or stomach preparation before endoscopic procedures. The research found that these patients had higher instances of food remaining in the stomach or stool in the bowel, potentially impacting the effectiveness of endoscopies or colonoscopies. However, no serious complications such as aspiration occurred. More research is needed to assess if updated guidelines for GLP-1 use before these procedures are necessary.
A bariatric surgeon has agreed to pay $45,000 to settle allegations of submitting false claims to Medicare and Medicaid. The settlement follows claims that the surgeon billed for procedures not supported by the necessary medical documentation. The case underscores the ongoing efforts to enforce healthcare fraud regulations and ensure compliance with proper billing practices in the medical field.
The NordICC trial on colorectal cancer (CRC) screening might have underestimated 10-year risk reductions due to delays in cancer registration, affecting study outcomes. Researchers estimate that delays of up to 3 years could have reduced the accuracy of risk reduction by as much as 75%. While screening colonoscopy’s impact appears weaker than anticipated, experts urge caution in interpreting results until full 10- and 15-year follow-up data are available to assess true reductions in CRC risk and mortality.
The FDA has granted breakthrough therapy designation to Sagimet Biosciences’ denifanstat for the treatment of metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced fibrosis. The designation is based on positive results from the phase 2b FASCINATE-2 trial, showing significant improvements in MASH resolution, liver fibrosis, and fat reduction.
Prior authorization is a process where insurance companies pre-approve certain treatments, often delaying care and creating obstacles for patients and doctors. A 2023 AMA survey found that 94% of physicians reported delays in patient care due to this process, with 24% citing patient harm. Reform is on the horizon, with ten states enacting legislation and Congress considering the bipartisan Improving Seniors’ Timely Access to Care Act to streamline prior authorizations and improve patient outcomes.
Dr. Stephanie D. Pointer, co-owner of Digestive and Liver Health Specialists, is a gastroenterologist with a special interest in inflammatory bowel disease (IBD). She finds fulfillment in identifying and treating precise causes of IBD, improving patients’ quality of life. Aside from her practice, she mentors aspiring medical professionals, offers shadowing opportunities, and previously ran a nonprofit teaching piano to underserved youth. In her spare time, she enjoys sewing, playing piano, and reading, particularly works by Stephen King.