May 23, 2024

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


Numerous Layoffs Hitting Healthcare

Numerous layoffs are hitting healthcare. In the health plan world there have been notable layoffs, including at United’s Optum. UPMC’s health system is laying off as is Walmart in its soon-to-be-shuttered healthcare division.

Additional articles: https://www.fiercehealthcare.com/finance/fierce-healthcare-layoff-tracker-highmark-axes-200-jobs-march and https://www.modernhealthcare.com/providers/walmart-health-layoffs-virtual-care-phoenix

(Some articles may require a subscription.)

#walmart #upmc #healthcare


Express Scripts Embracing Independent Pharmacies

In an effort to boost its image after bad press regarding pharmacy benefits managers (PBMs), Express Scripts is entering into a program to boost independent pharmacies through clinical services.

Additional articles: https://www.modernhealthcare.com/insurance/express-scripts-cpensn-usa-medicare-diabetes-hypertension and https://www.fiercehealthcare.com/payers/express-scripts-cpesn-team-support-independent-pharmacies-providing-key-services

(Some articles require a subscription.)

#pbms #pharmacies


CVS Seeking Investors To Expand Oak Street

CVS made a major investment in Oak Street, a primary care entity for seniors. It now is seeking to expand it, but wants to hedge its bets by including an outside investor. Probably smart given some high-profile failures in the primary care and retail healthcare world.

(Article may require a subscription.)

#cvshealth #primarycare #retailmeetshealthcare


Hospital Prices Rising

We reported on the return of aggressive hospital cost inflation recently. More details on the 7.7% year-over-year increase from 2022 to 2023.

(Article may require a subscription)

#hospitals #costs


Stopping The Revolving Door At The FDA

I have argued that the Food and Drug Administration (FDA) is fundamentally broken due to the stunning revolving door between it and drug makers. A new bill would stop this at the FDA and the National Institutes of Health (NIH). There would be an 8-year prohibition on taking a job at a regulated industry.

(Article may require a subscription.)

#fda #revolvingdoor #lobbying


Good Analysis Pushes Back On Magnitude Of Overpayments In MA

An excellent Health Affairs Forefront blog pushing back on the opponents’ arguments on Medicare Advantage (MA) overpayments. It rips apart many of MedPAC’s, the congressional policy arms, analyses. I won’t give away everything as this is a must read, but here are some highlights:

  • Seniors and people with disabilities are challenged by rising premiums and costs in Medicare.
  • Over 50% are now in MA due to the value it brings enrollees. Traditional Medicare can’t compete.
  • It challenges assumptions on the $80 billion overpayment figure, arguing beneficial selection and quantifying overpayments are hard to quantify. It notes that if two large plans have half of membership, the figure cannot be right as half the $80 billion is well north of pre-tax income for those plans.
  • It also notes that if there are overpayments, they do go toward augmenting benefits in Medicare.
  • The Risk Adjustment Data Validation (RADV) program would solve bad behavior. I think it needs a more rational approach, but they are right.
  • Raises some challenges with health risk assessments and chart reviews.
  • The entire issue is in need of better studies and analysis and indiscriminate cuts need to be avoided given impacts on enrollees.

See my recent blog on the subject. I echo some of this and recommend plans be ready for some reining in of chart reviews and health risk assessments: https://www.healthcarelabyrinth.com/will-cms-rein-in-risk-adjustment-submissions/ . Stay tuned for my 5/31 podcast on this same subject.

#medicareadvantage #riskadjustment #radv #overpayments


Kaiser Finds 22.4 Million Disenrolled For Some Time From Medicaid

The Kaiser Family Foundation’s (KFF) latest analysis of the return of Medicaid redeterminations shows that 22.4 million were disenrolled for some period of time. It says there are about one-quarter redeterminations remaining. This seems higher than reported earlier. About 70% of disenrollments were for procedural reasons. Other studies show that net enrollment decreases (adding in others who joined since March 2023) are over 10 million.

#medicaid #redeterminations #coverage


— Marc S. Ryan

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