More Suits On No Surprises Act
UnitedHealthcare joins the ranks of Elevance Health and Aetna in suing prominent provider entities over the No Surprises Act. United is suing Radiology Partners and its Arizona-based affiliate, Sonoran Radiology, alleging the companies have been “abusing” the No Surprises Act’s independent dispute resolution process. They argue the radiology provider behemoth is “funneling millions into the pockets of its private-equity owners.”
The lawsuit comes after a Health Affairs study that shows that providers overwhelmingly win disputes and are awarded extremely high payments. Another new study also shows that surprise bills have fallen under the act based on data from states that had some protections and those that did not before the national law took effect. The study also notes that the prediction that the process would lower prices and save has not materialized.
The fact remains the law needs major reform, including requiring the qualifying payment amount to have more weight in the process.
Additional article: https://www.fiercehealthcare.com/regulatory/study-suggests-no-surprises-act-protections-are-reducing-patients-out-pocket-costs
#nsa #nosurprisesact #transparency #providers #healthplans
CDC Director Fired
The Trump administration has fired the new director of the Centers for Disease Control and Prevention (CDC) over the fact that Susan Monarez has refused to toe the line on a number of controversial moves by Health and Human Services Secretary Robert F. Kennedy, Jr. regarding vaccines. The firing also led to numerous high-level resignations.
Sen. Bill Cassidy, Chair of the HELP Committee, declared that his committee would undertake oversight over the ongoing CDC shakeup.
#cdc #hhs #rfkjr #trump
https://thehill.com/homenews/senate/5474700-bill-cassidy-senate-oversight-cdc-departures
Survey Says: Trends in Healthcare Consulting
A new survey of management consulting firms shows that the top demands for consulting services are in the area of operational improvement, margin improvement, and data analytics. Much of this is likely spurred on by the financial crisis at health plans as well as major regulatory changes from the Trump administration, including passage of sweeping healthcare cuts revenue. Artificial intelligence and data analytics are viewed as the leading innovations driving demand for healthcare consulting, according to the survey.
(Article may require a subscription.)
#healthcare #healthplans #providers #margins
https://www.modernhealthcare.com/providers/mh-healthcare-consultants-trends-ai-mergers
MA Plans Deny Post Acute Care
A survey by the American Health Care Association, a nursing home and other facility association, concludes that Medicare Advantage (MA) plans deny post-acute care on a daily or weekly basis for members in a majority of nursing homes — often against the advice of medical professionals. At the same time, a new MA rule requires MA plans to take at face value and not prior authorize post acute care when recommended by a physician.
#medicareadvantage #priorauthorization #nursinghomes
https://www.healthcaredive.com/news/medicare-advantage-post-acute-nursing-home-denials-ahca/758777
— Marc S. Ryan
