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Physician Pay Up; Docs Want Medicare Fix

Physician pay increased by 5.9% in 2023 after dropping 2.4% in 2022. At the same time, physician groups were on Capitol Hill lobbying for a Medicare physician payment fix and more changes to prior authorization. Some indicated that it was hard to compete against hospital-owned docs because of higher payments. The independent docs want site-neutral payments implemented.

Additional article: https://www.fiercehealthcare.com/providers/20-highest-paid-specialties-2023-doctors-see-6-boost-pay-doximity

#physicians #rates #medicareadvantage #medicare #priorauthorization #siteneutral

https://www.medpagetoday.com/practicemanagement/reimbursement/110302

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Providers Lose 340B Lawsuit Appeal To Drug Makers

A U.S. Court of Appeals ruled that drug makers can limit and impose conditions on pharmacies participating in the 340B drug discount program. The federal government had sided with providers, but a federal court ruled against that position.

I am no friend of drug makers but this ruling is a good one.  The 340B program has been corrupted and abused by providers. It is not fulfilling its mission of getting discounted drugs to the most vulnerable. 

Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/second-appeals-court-rules-drug-makers-can-impose-340b-restrictions

(Some articles may require a subscription.)

#340b #drugmakers #hospitals #providers

https://www.healthcaredive.com/news/appellate-court-rules-drugmakers-340b-novartis-pharmacies-specialty/716814

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Wyden Wants Tough Stance On Exchange Agents and Brokers

Finance Chair Ron Wyden wants the Centers for Medicare and Medicaid Services (CMS) to crack down on rogue brokers and agents in the nation’s Exchange signup process. 

(Article may require a subscription.)

#exchanges #agents #brokers #fwa 

https://www.modernhealthcare.com/insurance/ron-wyden-cms-exchange-marketers-aca

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Optum Announces Transparent-Like Pharmacy Model

Pressured by the rise of transparent pricing models, Optum Rx has announced its own approach to greater transparency. I would call it transparency-like. It is offering a single per member cost, encompassing retail, home delivery, specialty drug and rebate components.

#transparency #pbms #optumrx

https://www.fiercehealthcare.com/payers/optum-rx-puts-emphasis-predictability-new-pricing-model

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Mental Health Inequities Have Huge Toll

Inequities in mental health will cost $332 billion on premature death and $116 billion in productivity loss in 2024. These combined numbers could grow to $1.3 trillion by 2040.

The inequities also mean greater healthcare spending. $5.3 billion in 2024 excess costs are tied to overutilization and excessive reliance on the emergency room for acute mental health incidents. That number could rise to $17.5 billion in 2040.

#mentalhealth #behavioralhealth #healthcare

https://www.fiercehealthcare.com/payers/mental-health-inequities-cost-478b-unnecessary-expenses-2024

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While Admirable, CalAIM Is Struggling

California has fashioned an ambitious healthcare and social service experiment known as CalAIM, but some aspects on the community health and services front are struggling. Many states have mimicked California by requesting similar but less ambitious initiatives through Medicaid. With the majority of health outcomes tied to social factors and not underlying clinical conditions, it is a worthy pursuit overall.  My fear is that California may be trying too much too quickly.

(Article may require a subscription.)

#ca #calaim #healthcare #sdohs #socialdeterminants #medicaid #managedcare

https://www.modernhealthcare.com/providers/california-medicaid-medi-cal-calaim-gavin-newsom-community-health-workers-nonprofits

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Bipartisan Senate Bill Would Reform Medicare Primary Doc Pay

A bipartisan bill would tell the Centers for Medicare and Medicaid Services (CMS) to establish hybrid payments to reward primary care providers in the Medicare fee-for-service (FFS) program who provide the best care to their patients, including reducing patients’ emergency visits, hospitalizations, excess specialist services, and other big cost drivers.

Additional article: https://insidehealthpolicy.com/daily-news/whitehouse-cassidy-unveil-primary-care-payment-reform-related-rfi

(Some articles may require a subscription.)

#primarycare #medicare

https://www.fiercehealthcare.com/providers/senators-both-sides-aisle-propose-primary-care-payment-reform-seek-industry-feedback

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Broussard To Step Down As Humana CEO

Bruce Broussard will step down as CEO of Humana on July 1 and be succeeded by Jim Rechtin, who came in as President and COO. Despite some challenges right now financially, he deserves tremendous credit for building a stellar MA business over a decade plus at the helm.  He tripled enrollment. Broussard will serve as a strategic advisor through 2026.

Additional articles: https://www.fiercehealthcare.com/payers/jim-rechtin-step-humana-ceo-role-july-1 and https://www.modernhealthcare.com/insurance/humana-jim-rechtin-bruce-broussard-ceo

(Some articles may require a subscription.)

#medicareadvantage #humana #broussard

https://www.healthcaredive.com/news/humana-ceo-transition-timeline-broussard-rechtin/716014

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Kaiser Reports Good Financial News

Kaiser Permanente reported $935 million of operating income (3.4% operating margin) and more than $2.7 billion of net income. This beats Q1 2023 dramatically. Kaiser is also looking to sell off up to $3.5 billion of its investment stakes.

Additional articles: https://www.modernhealthcare.com/finance/kaiser-permanente-investments-wsj and https://www.beckershospitalreview.com/finance/kaiser-posts-935m-operating-profit-in-q1.html

(Some articles may require a subscription.) 

#kaiserpermanente #healthplans #hospitals

https://www.fiercehealthcare.com/finance/kaiser-permanente-posts-34-operating-margin-billions-net-income-q1-2024

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DOJ Sets Up Antitrust Task Force

The U.S. Department of Justice (DOJ) has set up a multi-disciplinary task force to examine healthcare monopolies and collusion. It will facilitate policy advocacy, investigations, and civil and criminal enforcement.

#antitrust #mergers #acquisitions #manda

https://www.fiercehealthcare.com/providers/justice-department-unveils-task-force-healthcare-antitrust-issues

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