January 23, 2024

Rural Hospitals In Distress

A good measure of the distress rural hospitals: most no longer deliver babies. Over half of the country’s rural hospitals aren’t offering labor and delivery services and more could end such services.

Some would argue that the rural hospitals’ plight could be solved by more money for hospitals overall.  The truth is the abominable hospital price system we have in this country along with the gross inefficiency of most hospitals drains overall healthcare resources and means we do not have enough to respond to true crises, such as those in rural communities.

#ruralhealthcare #hospitals

Link to Article

Good Summary Of New Interoperability Rule’s Impact On Health Plans

Modern Healthcare has a good article summarizing the provisions and impacts of the new interoperability rule.  Among the mandates are a swifter turnaround time for medical service authorizations in 2026 and the new FHIR electronic prior authorization process in 2027.

There is a national retail drug pharmacy electronic prior authorization standard that has been widely adopted for years now.  It drives electronic prior authorization, reduces costs for providers and plans, and hastens decision timeframes.  The same can happen with medical services. 

(Article may require a subscription.)

#priorauthorization #healthplans #providers #fhir

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Social Benefits Covered By Medicaid

Another good Modern Healthcare article on Medicaid waivers to cover social benefits in states.  Eight states now have major waivers in this area, with several others dabbling. 

(Article may require a subscription.)

#socialdeterminants #sdoh #medicaid

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U.S. Healthcare Spending Vs. Other Countries’

The Peterson-Kaiser Family Foundation Health Tracker has refreshed its chart collection on our healthcare spending vs. other nations.  I speak often about this topic in my blogs and my book, The Healthcare Labyrinth (available from this site).  Its conclusions are similar to mine.  Some of the key findings from Peterson-KFF:

  • Comparable wealth countries spend about half per capita what the U.S. does.
  • Our spending as a percentage of gross domestic product (GDP) is also much higher.
  • Recent annual growth rates in the U.S. however, have been less than other nations.

#healthcare #healthcarereform #spending

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Bizarre Study By Census Bureau And VA On Efficiency

I am having a hard time understanding the purpose of this study unless it is just blatantly political.  The study seeks to argue that somehow the VA is efficient and private healthcare could learn a lot about reducing administrative costs.  It does note that part of its lower administrative costs relate to the fact that it does not need to collect revenue in a billable sense. And it is right that private healthcare would benefit from a streamlined system. But have the authors forgotten about the long waiting lists and terrible conditions of many VA facilities.  How can they even imply care there is better?

#va #healthcare #healthcarereform

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Widen Turning Up Heat On Third Party MA Marketing

Senate Finance Committee Chairman Ron Wyden, D-OR, continues to push marketing reform in Medicare Advantage (MA).  He has sent a letter to five third-party marketing organizations inquiring about their business practices, including the use of lead generators. The Centers for Medicare and Medicaid Services (CMS) has ramped up scrutiny with MA plan oversights and audits as well as new rules that rein in practices during enrollment seasons.  As well, CMS wants to reduce compensation going to the agencies from MA plans.

Additional article here: https://insidehealthpolicy.com/daily-news/wyden-queries-ma-third-party-marketing-orgs-relationship-lead-generators

(Articles may require a subscription.)

#medicareadvantage #marketing

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NYC To Cancel Medical Debt

NY State is attempting to rein in surprise billing and medical debt.  Now, NYC Mayor Eric Adams says the city will pay about $18 million to eliminate about $2 billion in residents’ medical debt.  This is done through a non-profit, which negotiates debt retirement for payments that are pennies on the dollar.

#medicaldebt #surprisebilling

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— Marc S. Ryan

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