April 2, 2024

Scrutiny Of Private Equity Healthcare Investments Expand

Private equity investments are already being broadly looked at by Congress and regulators.  Now, the Senate Homeland Security and Governmental Affairs Committee is seeking information on private equity’s role in emergency physician staffing firms that are leaving hospital emergency departments unprepared.

Letters were sent to Apollo Global Management, the Blackstone Group and KKR — three of the nation’s largest private-equity firms — and four emergency medicine staffing companies owned by the firms.  It is estimated at least 40% of hospital emergency departments are overseen by staffing companies that are owned by private-equity firms.

Additional article: https://www.fiercehealthcare.com/providers/senator-probes-private-equity-physician-staffing-firms-emergency-care-cost-cutting

#privateequityfirms #healthcare

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MA Plans Say Rate Hike For 2025 Will Have Dire Consequences

Health plans are pummeling the Centers for Medicare and Medicaid (CMS) for finalizing what they see as an inadequate 2025 rate hike.  Plans say this will force them to reduce key supplemental benefits relied on by those with low and fixed incomes.  In addition, it is not just payers who will be impacted. Risk-bearing providers have seen the surpluses in their global and partial risk funds dry up and that could continue.
Better Medicare Alliance statement: https://bettermedicarealliance.org/news/better-medicare-alliance-statement-on-cy25-medicare-advantage-and-part-d-final-rate-notice/

#medicareadvantage #rates #providers

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Kaiser Closes On Geisinger Health; Optum To Buy Steward Health Care Physicians

Kaiser Permanente closed on its acquisition of Geisinger, the first of a planned national expansion of its integrated provider and insurance model.  Meanwhile, United’s services unit, Optum, will buy beleaguered Steward Health Care’s physician group.

Additional articles: https://www.fiercehealthcare.com/finance/healthcare-dealmakers-elevance-acquire-kroger-specialty-pharmacy-optum-buy-stewards and https://www.modernhealthcare.com/mergers-acquisitions/risant-health-kaiser-permanente-geisinger-deal

(Some articles may require a subscription.)

#manda #mergers #acquisitions #kaiserpermanente #healthcare

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Physician Pay Dropped In 2022

Average physician pay dropped by 2.4% in  2022, hitting providers as they grapple with a growing physician shortage issue and high rates of burnout.  This comes from a survey by Doximity. The article also ranks pay by specialties.

#physicians #providers

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Marketplace Exchange Changes Finalized In New CMS Rule

The Centers for Medicare and Medicaid Services (CMS) finalized changes to the Marketplace Exchanges in a rule today.  Among the numerous changes are network adequacy standards based on the time and distance patients have to travel for in-network care (beginning in 2026), alignment of the annual open enrollment period for state-based exchanges with the federal one, and more liberal special enrollment periods for lower income Americans.

CMS press release and fact sheet: https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2025-final-rule and https://www.cms.gov/newsroom/press-releases/hhs-finalizes-policies-make-marketplace-coverage-more-accessible-and-expand-essential-health

(Some articles may require a subscription.)

#aca #obamacare #exchanges 

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Fitch Does Not Expect Negative Credit Issues With Non-Profit Hospitals Due To Cyberattack

Fitch Ratings says it does not anticipate a credit impact to nonprofit hospitals as long as providers return to normal operations in the near term. It notes that most maintain a large enough cash cushion. Much bigger fears exist for the smaller providers out there.

#changehealthcare #providers #cyberattacks

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New Study Says Medicaid Rolls Down By About 12 Million

A new study says that there are 12 million fewer Americans on Medicaid rolls now when compared with levels before Medicaid redeterminations were reintroduced a year ago. The number who have lost enrollment during the redeterminations is now approaching 20 million.  The last study to estimate the actual losses overall was a few months ago and at the time the loss was about 9.5 million.  So the bleeding continues.  The analysis notes the biggest impacts are on people of color. 

(Article may require a subscription.)

#medicaid #redterminations #enrollment #coverage

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New Frauds In Healthcare

Several new frauds being reported in healthcare.  In one, Kaiser State News reports that people are being fraudulently switched to different plans without their knowledge. As well more details on fraudulent billing in Medicare fee-for-service (FFS) for phantom procedures.

In related news, prices are becoming so high that the federal government had to amend claims forms and its claims processing system to add two more digits for acceptance of provider reimbursement requests. Imagine!

Additional articles: https://www.statnews.com/2024/04/02/medical-bills-medicare-claim-forms-run-out-of-space-for-high-prices/ and https://kffhealthnews.org/news/article/aca-obamacare-plans-switched-without-enrollee-permission-investigation/

(Some articles may require a subscription.)

#fwa #medicare #exchanges

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Weight-Loss Drug Approval Could Hike Medicare Premiums

More hidden impact of out-of-control drug prices in America: Part D premiums could increase due to recent approvals for use of weight-loss drugs for treatment of people with certain disease states. Premium hikes could occur as early as 2026, if not sooner if health plans take the approval into consideration for 2025 bids.

Several years ago we saw Medicare Part B premiums shoot through the roof due to the approval of a controversial and now failed Alzheimer’s drug. Aduhelm.  Now there are fears that Wegovy, which was just approved for use for those who are overweight or obese and have cardiovascular disease, could cause Part D premiums to skyrocket in the future.

The Centers for Medicare and Medicaid Services (CMS) approved coverage of Wegovy in Part D after the Food and Drug Administration (FDA) approved the expanded use. The drugs are not authorized in Medicare for general weight-loss. Prior authorization (PA) and other utilization controls can be used. Similar drugs are currently in use for those with diabetes and obese or overweight.  Costs for the drugs have skyrocketed already in the past several years due to use with diabetes.

Additional article: https://www.beckerspayer.com/payer/medicare-premiums-may-rise-as-plans-move-to-cover-wegovy.html

#weightlossdrugs #medicareadvantage #partd #pdp #medicare

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Excellent Blog On Gargantuan United HealthGroup’s Optum Services Entity

Great blog on the sheer size of Optum, the United HealthGroup services subsidiary.  Change Healthcare is a small part of the Optum enterprise and the blog goes through various components, from Optum Rx (a PBM), Optum Insights, as well as provider assets.

#united #optum #changehealthcare

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— Marc S. Ryan

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