沃尔纳特山研究揭示了导致延误、拒绝和患者放弃的系统性医保优势障碍-动脉网

Walnut Hill Study Exposes Systemic Medicare Advantage Barriers Causing Delays, Denials, and Patient Abandonment

CISION 等信源发布 2025-06-04 04:50

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DALLAS

达拉斯

，

June 3, 2025

2025年6月3日

/PRNewswire/ -- Walnut Hill Medical has released findings from its MAD (Medicare Advantage Denial) Study, revealing that Medicare Advantage plans are systematically delaying or denying access to a non-opioid, non-steroidal chronic pain treatment: Peripheral Nerve Stimulation (PNS).

/PRNewswire/ -- 沃尔纳特希尔医疗公司发布了其MAD（Medicare Advantage拒绝）研究的调查结果，揭示了Medicare Advantage计划正在系统性地延迟或拒绝一种非阿片类、非甾体类慢性疼痛治疗——周围神经刺激（PNS）的获取。

Based on a proprietary dataset of 1,210 Medicare Advantage patients who sought prior authorization for PNS in 2024, the study paints a troubling picture—raising urgent concerns about transparency, equity, and access in America's most popular form of Medicare coverage.

基于一个包含1210名寻求PNS预授权的Medicare Advantage患者的数据集，这项研究揭示了一个令人担忧的情况，引发了人们对美国最受欢迎的Medicare覆盖形式在透明度、公平性和可及性方面的紧迫担忧。

'Prior authorization isn't just a bureaucratic hurdle—it's being weaponized to deter care,' said

“事先授权不仅仅是一个官僚主义的障碍——它正在被用作阻止治疗的武器，”

Chris Hanna

克里斯·汉纳

, CEO of Walnut Hill Medical. 'Transparency is the first step toward accountability.'

，核桃山医疗公司的首席执行官。“透明度是迈向责任的第一步。”

Understanding the Issue: What Is Medicare Advantage and Prior Authorization?

理解问题：什么是医疗保险优势计划和事先授权？

Medicare Advantage (Medicare Part C) is a private alternative to traditional Medicare, now covering over half of all Medicare beneficiaries. These plans are managed by private insurers and often tout extra benefits—but they also impose stricter controls, including prior authorization (PA) requirements for many medical services..

Medicare Advantage（Medicare Part C）是传统 Medicare 的私人替代方案，现已覆盖超过一半的 Medicare 受益人。这些计划由私人保险公司管理，通常宣称提供额外福利，但同时也施加了更严格的控制，包括对许多医疗服务的预先授权（PA）要求。

Prior authorization requires providers to obtain insurer approval before delivering care. While designed to ensure medical necessity and control costs, PA can also result in significant care delays—or outright denials.

事先授权要求提供者在提供护理之前获得保险公司的批准。虽然旨在确保医疗必要性并控制成本，但事先授权也可能导致显著的护理延误或直接拒绝。

The 2022 Warning That Went Unheeded

2022年的警告未被重视

In 2022, the Office of Inspector General (OIG) found that 13% of denied services in Medicare Advantage met Medicare coverage criteria and should have been approved. The OIG warned that plans may be inappropriately restricting access to necessary care.

2022年，监察长办公室 (OIG) 发现，在Medicare Advantage中，有13%的被拒绝服务符合Medicare覆盖标准，本应获得批准。OIG警告称，计划可能正在不恰当地限制对必要护理的获取。

Walnut Hill's 2024 data show the problem is even worse—especially for patients seeking advanced therapies like PNS.

核桃山2024年的数据显示问题更加严重，尤其是对于那些寻求PNS等先进治疗的患者。

Key Findings: Denials, Drop-Off, and Delays in Pain Treatment Access

关键发现：疼痛治疗获取的拒绝、中断和延迟

PNS is a minimally invasive, FDA-cleared therapy for chronic pain. Walnut Hill's study found:

PNS是一种微创的、经FDA批准的慢性疼痛治疗方法。核桃山的研究发现：

29% of patients were denied on their first prior authorization attempt—more than twice the OIG's 2022 benchmark.

29%的患者在首次事先授权申请时被拒绝，这一比例是OIG 2022年基准的两倍多。

28% of patients abandoned care after an initial denial—never appealing or resubmitting.

28% 的患者在初次被拒后放弃了治疗——既没有上诉也没有重新提交。

Among those who appealed:

在那些上诉的人中：

56% had their denial overturned.

56% 的拒绝被推翻。

69% who escalated to a Medicare hearing (OMHA) were approved.

69% 的人上诉至联邦医疗保险听证会 (OMHA) 后获得批准。

'This isn't just inefficiency,' Hanna said. 'It's a sorting mechanism that weeds out patients without time, resources, or strong clinical advocates.'

“这不仅仅是效率低下，”汉娜说，“这是一种筛选机制，会把那些没有时间、资源或强大临床支持的患者排除在外。”

The Cost of Denial: Financial Incentives and Patient Harm

否认的代价：经济激励与患者伤害

Of the 1,210 patients studied, 210 were denied and never received their PNS therapy. Based on 2024 Medicare Advantage reimbursement rates, Medicare Advantage plans withheld

在研究的1210名患者中，有210名患者被拒绝且从未接受他们的PNS治疗。根据2024年联邦医疗保险优势计划的报销率，联邦医疗保险优势计划扣留了相关费用。

$6.2 million

620万美元

worth of care from patients—highlighting how administrative attrition reduces cost at the patient's expense.

患者所付出的代价——突显了行政上的消耗如何以患者的费用为代价来降低成本。

A Call for Oversight and Reform

对监督和改革的呼吁

'Medicare Advantage now covers the majority of eligible seniors,' said Hanna. 'With that dominance must come responsibility. Our data show that without reform, prior authorization becomes a silent gatekeeper—not just delaying care but denying it altogether.'

“联邦医疗保险优势计划现在覆盖了大多数符合条件的老年人，”汉娜说。“随着这种主导地位的到来，必须承担相应的责任。我们的数据显示，如果不进行改革，事先授权将成为一个隐形的把关者——不仅延误治疗，还会完全拒绝治疗。”

Walnut Hill is urging lawmakers to strengthen transparency and accountability provisions in the bipartisan Improving Seniors' Timely Access to Care Act of 2025, introduced by Rep.

核桃山敦促立法者加强2025年两党《改善老年人及时获取医疗法案》中的透明度和问责条款，该法案由众议员提出。

Mike Kelly

迈克·凯利

(R-PA).

（R-PA）。

Download the Full Report

下载完整报告

The complete MAD Study, including detailed methodology, statistics, and patient-level analysis, is available here:

完整的MAD研究，包括详细的方法论、统计数据和患者层面的分析，可在此处获取：

MAD-Study.WalnutHillMedical.com

MAD研究.沃尔纳特希尔医疗.com

About Walnut Hill Medical

关于核桃山医疗

Walnut Hill Medical partners with medical device companies, providers, life sciences organizations, and patients to deliver expert reimbursement strategy, health policy insights, and seamless prior authorization support. Their mission: Empower innovators to deliver care, enable doctors to focus on patients, and help patients access the therapies they need—without administrative barriers..

核桃山医疗与医疗器械公司、供应商、生命科学组织和患者合作，提供专业的报销策略、卫生政策见解和无缝的预授权支持。其使命是：赋能创新者提供医疗服务，让医生专注于患者，并帮助患者在没有行政障碍的情况下获得所需的治疗。

Resources:

资源：

Walnut Hill Medical MAD Study:

核桃山医疗MAD研究：

https://mad-study.walnuthillmedical.com/

Full OIG Report:

完整OIG报告：

https://oig.hhs.gov/documents/audit/10207/A-05-24-00015.pdf

Improving Seniors' Timely Access to Care Act of 2025:

2025年改善老年人及时获得医疗法案：

https://regrelief.org/wp-content/uploads/2025/05/KELLPA_028_xml.pdf