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Tuesday, April 8, 2025

Doc warns men about 2 common health mistakes — as John Cena reveals he’s had cancer

 John Cena dropped the bombshell news last week that he quietly overcame skin cancer, having previously had two cancerous spots removed from his pec and shoulder.

“Man, that phone call’s not what you want to get because it is unpredictable and you don’t know how bad it’s going to be,” Cena, 47, told People.

But the actor and WWE star admitted that he had long been “stubborn” about sun protection — and according to a dermatologist, he has that in common with a lot of men who tend to make two pretty big mistakes when it comes to cancer prevention.

WWE star John Cena revealed last week that he has had two cancerous moles removed.WWE via Getty Images

No sunscreen? Big problem

Cena said he “never” wore sunscreen growing up, and that followed him into adulthood.

“I didn’t want to have a routine and I also thought the problem would never reach me. And it’s one of those things where I had a ton of exposure with minimal protection and it caught up with me,” he said.

It wasn’t until he went to see a dermatologist for a routine checkup that he got the wake-up call he needed.

“I’m at a great space in my life where that’s now important to me. And I’m so grateful to be able to dodge those two bullets, but I wear them as a reminder of, ‘Hey man, you need to take the extra few seconds to protect yourself every day,’” he said.

To that end, he recently teamed up with Neutrogena Ultra Sheer sunscreen for its latest campaign and hopes to encourage others to get serious about taking care of their skin.

Costly mistakes

It’s a message more men, in particular, may need to hear, since many tend to be less proactive about healthcare.

“Men tend to think less about regular preventive care because there’s not a lot of guideline-based preventive care for men compared to women,” Dr. Victor Quan, a dermatologist at Northwestern Medicine, told The Post.

Quan pointed out that while women may ask for a skin exam since they’re already at the doctor’s for other conditions like acne or rosacea, men will often avoid a visit until something is clearly wrong.

“In general, I see more women making appointments for regular preventive visits,” he said. “Men tend to come in when they or often, when their partner, notices a new or changing spot.”

“It’s one of those things where I had a ton of exposure with minimal protection and it caught up with me,” Cena said.WWE via Getty Images
Even then, they sometimes choose to simply ignore it — which could have serious consequences.

“Men sometimes do come in with skin cancers that are larger or more progressed,” he said, and “they don’t feel that bothered by a bump that would otherwise make someone else worried.

“Sometimes, they don’t know what skin cancers look like — that they don’t have to be ugly moles but can be warts, pimples or scaly spots that are just not healing.”

Shockingly, he noted that some men “just haven’t been to any kind of a doctor” for 25 to 30 years.

A 2018 study published in JAMA Dermatology found the men had a 34% lower likelihood of visiting a dermatologist than women.

That being said, Quan did note that he’s been “seeing a recent trend of more men asking for skin checks purely on a preventive basis or even just asking for a ‘good skincare routine'” — a development he credits at least in part to social media.

He’s teamed up with Neutrogena for a new campaign for their Ultra Sheer SPF.Kenvue Inc.
But there’s another major blind spot that needs to be tackled — ignorance surrounding the significance of daily SPF.

“Men tend to know less about the importance of sun protection — such as that a base tan does not protect you from UV damage,” Quan said.

“Sun protection is so normalized for women, since so many cosmetic products now have SPF built in, whereas men are not using make-up, moisturizers or other products on a daily basis.”

That kind of thinking can have real consequences.

Research shows that men are more likely to develop skin cancer on areas like the scalp, face and neck — areas that often go unprotected during outdoor activities, according to Dr. Neera Nathan, a dermatologist and skin cancer surgeon.

“Sometimes, [men] just haven’t been to any kind of a doctor for 25 or 30 years,” Dr. Victor Quan told the Post.Kenvue Inc.
“My recommendation to all my patients, male or female, is to practice good sun protective behaviors, including seeking shade during peak sun hours, wearing broad-brimmed hats — remember, as we age, our hair thins, so our scalp becomes even more vulnerable to sun damage — sunglasses with UV protection, sun-protective clothing and wearing sunscreen on any exposed skin,” Nathan told The Post.

She recommends choosing a sunscreen that is water-resistant, contains SPF 30 or more and includes broad-spectrum UVA/UVB protection.

Most, importantly, “it is best to find a sunscreen you like — texture, feel, finish — because the best sunscreen is one you will actually wear,” she said.

Indeed, Cena told People that one of the reasons he loves the new Neutrogena Ultra Sheer line is because, following his diagnosis, he wanted “the highest SPF” sunscreen he could get his hands on, but “that stuff, it’s great for you, but it [leaves] a very white cast…like you’re wearing medicine.”

Getting sunscreen you’re going to actually use on a daily basis is critical because consistency is key — it could literally save your life.

“I give men the same advice that I give women, that sun exposure is the biggest modifiable risk factor for skin cancer,” Quan told The Post.

“I’m not asking them to stop all their outdoor activities — just to make the benefits of small habits add up over a lifetime. Every little bit counts. It compounds just like investments do.”

https://nypost.com/2025/04/08/health/doctors-warning-to-men-as-john-cena-reveals-hes-had-cancer/

KUDLOW: A new playbook and pecking order

 Less than a week after Liberation Day, the White House seems to have changed both the playbook and the pecking order regarding its reciprocal tariff campaign.  

Perhaps the stock market plunge, or the phone calls from foreign leaders, or both, have contributed to a shift in President Donald Trump’s strategy – to negotiation, from non-negotiation.

Just call it: common sense.

As someone who strongly supports his reciprocal trade policy, I’d say this is a very good thing.

In the Oval Office he gave Israeli Prime Minister Benjamin Netanyahu a signed copy of "The Art of the Deal." How fitting.

Last night in my interview with Treasury Secretary Scott Bessent, he talked about being a very busy chap in the next few months. 

"I can tell you that there are 50, 60, maybe almost 70 countries now who have approached us," Mr. Bessent said. "So it’s going to be a busy April, May, maybe into June. And Japan is a very important military ally. They’re a very economic ally. And the U.S. has a lot of history with them. So I would expect that Japan’s going to get priority."

And, besides a change in the negotiating playbook, it also looks like a big change has come in the pecking order.

Suddenly, Mr. Bessent appears to be the lead negotiator.

Now, here’s how Mr. Trump’s press secretary, Karoline Leavitt, put it.

"Just yesterday, President Trump held a bilateral meeting with Israeli Prime Minister Benjamin Netanyahu here at the White House," she said. "Also yesterday, the President spoke with Japan’s Prime Minister, who wants to negotiate as well. The President also spoke with the acting president of South Korea this morning. He has tasked Secretary Bessent and U.S. Trade Representative Jamieson Greer to lead these talks."

There was a time when Commerce Secretary Howard Lutnick was designated the lead trade negotiator, but Mr. Bessent seems to have replaced him.

And this bodes well for a true approach to reciprocal trade dealing.

Both Mr. Bessent and U.S. Trade Representative Greer are more flexible regarding the so-called reciprocal tariffs first posted on Liberation Day. They are way too high.

That’s because they rely way too much on somehow abolishing the American trade deficit. A highly flawed and mistaken calculation.

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Think of it this way: if Mr. Trump’s economic plan of tax cuts, deregulation, liquid gold, and reciprocal fair trade is put in place, America will grow faster than probably any major country in the world.

Which means that we will purchase more imports as we grow.

The key goal for reciprocal trade, however, is to open up export markets to America that have previously been closed either because of high tariffs or non-tariff barriers.

In other words, market access should be the key objective, not abolishing the trade deficit.

The latter could come down if the former is successfully opened.

Yet the only way to guarantee a trade balance in goods is a prolonged deep recession, and surely nobody wants that.

Not all of Mr. Trump’s advisers agree with this. Yet I believe the true purpose behind Mr. Trump’s thinking is zero tariffs, and zero non-tariff barriers.

And, when you look at countries like India, Taiwan, Vietnam, Japan, and South Korea, or Europe, there’s plenty of work to be done to level the playing field for both tariff and non-tariff barriers.

But the tariff gaps are not near as big as Mr. Trump’s original list would suggest if calculated properly, without the unnecessary goal of eliminating the trade gap altogether.

Now, let’s go make some good trade deals. That’s the order of the day.

https://www.foxbusiness.com/politics/larry-kudlow-new-playbook-pecking-order

Roche: Phase III OCREVUS high dose in MS misses primary endpoint

 

  • MUSETTE trial was designed to determine whether a higher dose of the currently approved OCREVUS IV 600 mg would provide additional benefit to people living with relapsing multiple sclerosis
  • The trial did not meet its primary endpoint; results support OCREVUS IV 600 mg as the optimal dose to slow disability progression
  • High dose was well tolerated with an overall comparable safety profile to OCREVUS IV 600 mg and no new safety signals observed
  • These data further support the efficacy and safety profile of OCREVUS IV 600 mg dose for RMS
  • OCREVUS set a new standard of care in multiple sclerosis and is the most prescribed disease modifying therapy in the United States with more than 400,000 people treated globally
  • https://www.roche.com/investors/updates/inv-update-2025-04-02b

Modifiable risk factors for stroke, dementia and late-life depression

 

  1. Jasper Senff et al.

Abstract

    1. Background At least 60% of stroke, 40% of dementia and 35% of late-life depression (LLD) are attributable to modifiable risk factors, with great overlap due to shared pathophysiology. This study aims to systematically identify overlapping risk factors for these diseases and calculate their relative impact on a composite outcome.

      Methods A systematic literature review was performed in PubMed, Embase and PsycInfo, between January 2000 and September 2023. We included meta-analyses reporting effect sizes of modifiable risk factors on the incidence of stroke, dementia and/or LLD. The most relevant meta-analyses were selected, and disability-adjusted life year (DALY) weighted beta (β)-coefficients were calculated for a composite outcome. The Î²-coefficients were normalised to assess relative impact.

      Results Our search yielded 182 meta-analyses meeting the inclusion criteria, of which 59 were selected to calculate DALY-weighted risk factors for a composite outcome. Identified risk factors included alcohol (normalised Î²-coefficient highest category: −34), blood pressure (130), body mass index (70), fasting plasma glucose (94), total cholesterol (22), leisure time cognitive activity (−91), depressive symptoms (57), diet (51), hearing loss (60), kidney function (101), pain (42), physical activity (−56), purpose in life (−50), sleep (76), smoking (91), social engagement (53) and stress (55).

      Conclusions This study identified overlapping modifiable risk factors and calculated the relative impact of these factors on the risk of a composite outcome of stroke, dementia and LLD. These findings could guide preventative strategies and serve as an empirical foundation for future development of tools that can empower people to reduce their risk of these diseases.
      https://jnnp.bmj.com/content/early/2025/03/21/jnnp-2024-334925

    Randomized Trial Tests Yoga as Knee Osteoarthritis Therapy

     

    • Exercise is believed to improve outcomes in osteoarthritis (OA) of the knee, but it's unclear whether some types are better than others.
    • This randomized trial tested yoga against strength training as therapy for knee OA.
    • Yoga was found noninferior to strength training and thus could be considered as a treatment option for knee OA.

    Patients with osteoarthritis (OA) of the knee got at least as much benefit from yoga as from conventional strength training in a randomized trial, researchers said.

    Pain was reduced about equally with yoga and strength training in the 117-person study, and yoga proved superior by certain other measures, according to Benny Antony, PhD, of the University of Tasmania in Hobart, Australia, and colleagues.

    Overall, the results indicated that yoga was noninferior to strength training and "that integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee OA," the group reported in JAMA Network Openopens in a new tab or window.

    Exercise therapy has long been recommended for patients with knee OA, as many studies have shown that it can reduce pain and delay the need for invasive treatment such as arthroplasty. Yoga is well recognized as a good whole-body workout and is recommended in published guidelines. But the same guidelines noted that the evidence base is extremely weak, because the underlying studies had problems such as small samples, short follow-up, and unclear comparators. Thus far, Antony and colleagues wrote, no studies had compared yoga to strength training, the exercise modality with the best support.

    For their trial, the researchers initially recruited 129 knee OA patients in the Australian island of Tasmania, 12 of whom were excluded or withdrew prior to the study's start; 58 were then randomized to yoga and 59 to strength training. Mean ages were 61 in the yoga group and 64 among those assigned to strength training. More than 70% were women. Body mass index values averaged 29 and 28 in the yoga and strength training groups, respectively. Pain was self-rated on a 100-point scale, with baseline averages of 54 in the yoga arm and 53 in the strength training group.

    Both programs were delivered in two hourlong in-person group sessions plus one at-home session each week for 12 weeks, with an additional 12 weeks of thrice-weekly at-home sessions. In-person training was given to groups of 10, each led by a trained professional. Strength training was centered on 45 minutes of various leg exercises, some with elastic bands and weights, conducted like a so-called circuit classopens in a new tab or window. The yoga program was designed specifically for knee OA patients. Sessions began with chanting and then rotated through sun salutations and asana and savasana poses (standing and floor-supported); some also utilized elastic bands.

    The interventions in both groups lasted 24 weeks, with the primary endpoint -- between-group difference in self-reported pain -- assessed at week 12. Secondary outcomes included pain at week 24 and measures from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Osteoarthritis Research Society International system, and other OA evaluation scales at weeks 12 and 24.

    That primary endpoint came out almost nil: -17.7 points relative to baseline in the yoga group, versus -16.7 with strength training, for a difference of -1.1 (95% CI -7.8 to 5.7). Pain ratings at week 24 favored yoga even more, though falling just short of statistical significance (-24.4 from baseline vs -18.6, P=0.11).

    Thirteen other outcome measures were assessed at weeks 12 and 24, for a total of 26 secondary endpoints. Of these, seven showed a significant advantage for yoga; none favored strength training (no statistical corrections were made, however, for the multiple comparisons). Most of these differences were seen at week 24: WOMAC pain, function, and stiffness; patients' global self-assessment; a "utility score" for overall health; and a 40-meter fast walk. One secondary outcome also indicated superiority for yoga at week 12, on the nine-item Patient Health Questionnaireopens in a new tab or window for depression symptoms.

    Adverse events were not infrequent -- about half of each group reported something -- but none were serious and only a small fraction were believed to stem from the interventions. Two patients in each group dropped out because of adverse events.

    Attrition was a problem in the trial, though. By week 12, each group had lost 13 participants, and two more quit in each group during the final 12 weeks. Most of the withdrawals were for nonspecified "personal" or "other" reasons. Although the main analyses were performed on an intention-to-treat basis, Antony and colleagues said they refrained from imputing data for those lost to follow-up, as their statistical models "assumed data are missing at random." In any event, per-protocol analyses including only those participants who completed their 12- and 24-week assessments yielded similar results.

    Limitations to the study included the relatively small number of participants who all lived in one Australian region. Also, it involved specific strengthening and yoga protocols, details of which may have been important for the outcomes.

    "While our findings are promising, further research is needed to investigate the long-term effects of yoga and strengthening exercises beyond the 24-week period, providing insights into the sustainability of benefits," Antony and colleagues observed. "Additionally, investigating the mechanisms underlying the observed improvements, such as pain, function, stiffness, physical performance, and depression, could yield a deeper understanding of how these interventions exert their effects."

    Disclosures

    The study was supported by the Rebecca L. Cooper Medical Research Foundation.

    Antony had no disclosures. Co-authors reported relationships with Eli Lilly, National Health and Medical Research Council, Medical Research Futures Fund, Wolters Kluwer, and Future Learn.

    Primary Source

    JAMA Network Open

    Source Reference: opens in a new tab or windowAbafita B, et al "Yoga or strengthening exercise for knee osteoarthritis: a randomized clinical trial" JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2025.3698.


    https://www.medpagetoday.com/rheumatology/arthritis/115010

    Using Only Air, Intranasal Device Treats Migraine Attacks

     An investigational device that delivered conditioned room air intranasally treated acute migraine attacks without drugs, a randomized sham-controlled study showed.

    Compared with sham, transnasal dry air flow at 10 L per minute using the Mi-Helper device was effective in treating acute migraine, said MaryAnn Mays, MD, of the Cleveland Clinic, in a late-breaking presentation at the American Academy of Neurologyopens in a new tab or window (AAN) annual meeting.

    Mi-Helper targets the sphenopalatine ganglion (SPG), a nerve bundle behind the nasal passages involved in migraine pathophysiology.

    "Using dry room-temperature air, Mi-Helper elicits local cooling of the nasal cavity, which calms or inhibits the SPG, relieving migraine pain and the need for medication," Mays said.

    Mi-Helper is the first noninvasive neuromodulation of the SPG to demonstrate efficacy, she pointed out. It consists of a tabletop device, tubeset, and drying cartridgeopens in a new tab or window. Air is drawn into the device, dried in the cartridge, and delivered to the patient through a single-use tubeset.

    Patients perceive the air as "cool, but not uncomfortable," Mays said. "Many patients feel it's very comfortable and soothing."

    Earlier researchopens in a new tab or window suggested that modulating the SPG through transnasal evaporative cooling provided relief from migraine attacks, she noted.

    The Mi-Helper trial was decentralized; participants self-administered the device in their homes. The study included 172 adults ages 18 to 65 who had episodic migraine. Overall, 128 participants were treated with Mi-Helper.

    A subset of 74 participants were included in the final efficacy analysis. Participants were randomized to one of three doses -- 4, 6, or 10 L per minute -- or sham treatment. They treated a single migraine attack for 15 minutes within 1 hour of migraine onset.

    The efficacy analysis included 14 people in the group receiving 4 L per minute; 18 people in the 6-L group, 17 people in the 10-L group, and 25 people in the sham group. Mean ages ranged from 38 to 44 years across groups, and more than 75% of the study sample were women. Most participants were white.

    The trial aimed to determine the most effective dose while assessing efficacy, safety, and tolerability. Primary endpoints were pain relief and pain freedom at 2 hours. Secondary endpoints included sustained pain freedom up to 24 hours.

    In the group receiving 10 L per minute, a higher percentage of participants were pain-free at 2 hours compared with the sham group (47.1% vs 16%, P=0.029). Pain relief at 2 hours was higher in the 10-L group compared with sham, but this was not significant (70.6% vs 56%, P=0.339).

    The percentage of participants who had sustained pain freedom from 2 to 24 hours was higher in the 10-L group compared with sham, but this trend also did not reach statistical significance (41.2% vs 16%, P=0.069).

    "The device was well tolerated and there were no treatment discontinuations or serious safety events," Mays said. All device-related adverse events were graded mild or moderate. At the 10-L dose, the most common adverse events were rhinorrhea, nasal irritation, ear pressure, and congestion.

    Recruitment for a decentralized pivotal trialopens in a new tab or window to further assess Mi-Helper began in March, Mays noted.

    "There's a critical need for alternative acute migraine treatments as many patients experience inadequate pain relief, intolerable side effects, or contraindications to existing therapies," she said at the AAN's top science press conference.

    "Neuromodulation is an expanding field in headache medicine, and multiple FDA-approved devices are available for migraine treatment," she added. "Mi-Helper offers a safe, effective, and accessible option used as a standalone treatment or with other existing therapies to help reduce the pain of migraine and decrease reliance on medications, including opioids."

    Disclosures

    This study was supported by Mi-Helper, Inc.

    Mays reported being a paid medical advisor and part of the study monitoring committee for Cool Tech, LLC.

    Primary Source

    American Academy of Neurology

    Source Reference: opens in a new tab or windowMays M "Mi-Helper transnasal cooling for acute migraine treatment: a prospective, double-blind, randomized, sham-controlled, decentralized dosing study" AAN 2025.


    https://www.medpagetoday.com/meetingcoverage/aan/115011

    Rural Hospitals Question Whether They Can Afford Medicare Advantage Contracts

     Rural hospital leaders are questioning whether they can continue to afford to do business with Medicare Advantage companies, and some say the only way to maintain services and protect patients is to end their contracts with the private insurers.

    Medicare Advantage plans pay hospitals lower rates than traditional Medicare, said Jason Merkley, CEO of Brookings Health System in South Dakota. Merkley worried the losses would spark staff layoffs and cuts to patient services. So last year, Brookings Health dropped all four contracts it had with major Medicare Advantage companies.

    "I've had lots of discussions with CEOs and executive teams across the country in regard to that," said Merkley, whose health system operates a hospital and clinics in the small city of Brookings and surrounding rural areas.

    Merkley and other rural hospital operators in recent yearsopens in a new tab or window have enumerated a long list of concerns about the publicly funded, privately run health plans. In addition to the reimbursement issue, their complaints include payment delays and a resistance to authorizing patient care.

    But rural hospitals abandoning their Medicare Advantage contracts can leave local patients without nearby in-network providers or force them to scramble to switch coverage.

    Medicare is the main federal health insurance program for people 65 or older. Participants can enroll in traditional, government-run Medicare or in a Medicare Advantage plan run by a private insurance company.

    In 2024, 56% of urban Medicare recipients were enrolled in a private plan, according to a reportopens in a new tab or window by the Medicare Payment Advisory Commission, a federal agency that advises Congress. While just 47% of rural recipients enrolled in a private plan, Medicare Advantage has expanded more quickly in rural areas.

    In recent years, average Medicare Advantage reimbursements to rural hospitals were about 90% of what traditional Medicare paid, according to a new reportopens in a new tab or window from the American Hospital Association. And traditional Medicare already pays hospitals much less than private plans, according to a recent studyopens in a new tab or window by Rand Corp., a research nonprofit.

    Carrie Cochran-McClain, chief policy officer at the National Rural Health Association, said Medicare Advantage is particularly challenging for small rural facilities designated critical access hospitalsopens in a new tab or window. Traditional Medicare pays such hospitals extra, but the private insurance companies aren't required to do so.

    "The vast majority of our rural hospitals are not in a position where they can take further cuts to payment," Cochran-McClain said. "There are so many that are just really in a precarious financial spot."

    Nearly 200 rural hospitalsopens in a new tab or window have ended inpatient services or shuttered since 2005.

    Mehmet Oz, MD, MBA -- former talk show host and newly confirmed head of the Centers for Medicare & Medicaid Services -- has promoted and worked foropens in a new tab or window the private Medicare industry and called foropens in a new tab or window "Medicare Advantage for all." But during his recent confirmation hearingopens in a new tab or window, he called for more oversight as he acknowledged bipartisan concerns about the plans' cost to taxpayersopens in a new tab or window and their effect on patients.

    Cochran-McClain said some Republican lawmakers want to address these issues while supporting Medicare Advantage.

    "But I don't think we've seen enough yet to really know what direction that's all going to take," she said.

    Medicare Advantage plans can offer lower premiums and out-of-pocket costs for some participants. Nearly all offer extra benefits, such as vision, hearing, and dental coverage. Many also offer perks, such as gym memberships, nutrition services, and allowances for over-the-counter health supplies.

    But a recent studyopens in a new tab or window in the Health Services Research journal found that rural patients on private plans struggled to access and afford care more often than rural enrollees on traditional Medicare and urban participants in both kinds of plans.

    Susan Reilly, a spokesperson for the Better Medicare Alliance, said a recent reportopens in a new tab or window published by her group, which promotes Medicare Advantage, found that private plans are more affordable than traditional Medicare for rural beneficiaries. That analysis was conducted by an outside firm and based on a government survey of Medicare recipients.

    Reilly also pointed to a studyopens in a new tab or window in the American Journal of Managed Care that found the growth of private plans in rural areas from 2008-2019 was associated with increased financial stability for hospitals and a reduced risk of closure.

    Merkley said that's not what he's seeing on the ground in rural South Dakota.

    He said traditional Medicare reimbursed Brookings Health System 91 cents for every dollar it spent on care in 2023, while Medicare Advantage plans paid 76 cents per dollar spent. He said his staff tried negotiating better contracts with the big Medicare Advantage companies, to no avail.

    Patients who remain on private plans that no longer contract with their local hospitals and clinics may face higher prices unless they travel to in-network facilities, which in rural areas can be hours away. Merkley said most patients at Brookings Health switched to traditional Medicare or to regional Medicare Advantage plans that work better with the hospital system.

    But switching from private to traditional Medicare can be unaffordable for patientsopens in a new tab or window.

    That's because in most states, Medigap plans -- supplemental plans that help people on traditional Medicare cover out-of-pocket costs -- can deny coverage or base their prices on patients' medical history if they switch from a private plan.

    Some rural health systems say they no longer work with any Medicare Advantage companies. They include Great Plains Healthopens in a new tab or window, which serves parts of rural Nebraska, Kansas, and Colorado, and Kimball Health Servicesopens in a new tab or window, which is based in two small towns in Nebraska and Wyoming.

    Medicare Advantage plans often limit the providers patients can see and require referrals and prior authorization for certain services. Requesting referrals, seeking preauthorization, and appealing denials can delay treatment for patients while adding extra work for doctors and billing staff.

    "The unique rural lens on that is that rural providers really tend to be pretty bare-bone shops," Cochran-McClain said. "That kind of administrative burden pulls people away from really being able to focus on providing quality care to their beneficiaries."

    Jonathon Green, CEO of Taylor Health Care Group in rural Georgia, said his system had to set up a team to deal solely with coverage denials, mostly from Medicare Advantage companies. He said some plans frequently decline to authorize payments before treatments, refuse to cover services they already approved, and deny payment for care that shouldn't need approval.

    In these cases, Green said, the companies argue that the care wasn't appropriate for the patient.

    "We hear that term constantly -- 'It's not medically necessary,'" he said. "That's the catchall for everything."

    Green said Taylor Health Care Group has considered dropping its Medicare Advantage contracts but is keeping them for now.

    Cochran-McClain said her group supports policy changesopens in a new tab or window, such as a federal billopens in a new tab or window that aims to streamline prior authorization while requiring Medicare Advantage companies to share data about the process. The 2024 bill was co-sponsored by more than half of U.S. senators, but needs to be reintroduced this year.

    Cochran-McClain said rural-health advocates also want the government to require private plans to pay critical access hospitals and similar rural facilities as much as they would receive from traditional Medicare.

    Green and Merkley stressed that they aren't against the concept of private Medicare plans; they just want them to be fairer to rural facilities and patients.

    Green said rural and independent hospitals don't have the leverage that urban hospitals and large chains do in negotiations with giant Medicare Advantage companies.

    "We just don't have the ability to swing the pendulum enough," he said.

    KFF Health Newsopens in a new tab or window is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF

    https://www.medpagetoday.com/publichealthpolicy/medicare/115016