Anesthesiology Digest: News from December 14, 2021.
HHS to Distribute $9B in COVID-19 Relief Funds to Smaller Providers This Week
By Robert King | December 14, 2021
The Department of Health and Human Services (HHS) announced it has distributed $9 billion in relief payments to providers to plug financial shortfalls caused by the pandemic, with more money going towards smaller providers.
The money is part of a $178 billion Provider Relief Fund and comes as HHS was criticized earlier in the year for not distributing the money fast enough. The agency said payments will reach providers later this week.
“This vital funding will ensure critical healthcare services are delivered to communities across the country—including to those who are disproportionately impacted by the pandemic and medically underserved,” said HHS Secretary Xavier Becerra in a statement.
HHS announced the payment methodology in September in order to give providers more insight into how to qualify for the money.
“Approximately 75% of Phase 4 funding is being distributed based on expenses and decreased revenues from July 1, 2020, to March 31, 2021,” HHS said in a release.
The Health Resources and Services Administration (HRSA) is also reimbursing more losses from smaller providers that were hit especially hard by the financial crisis caused by the pandemic.
HRSA is doling out 25% of the funding as a bonus payment based on the amount and services provided to Medicare, Medicaid or patients with the Children’s Health Insurance Program.
“HRSA is using Medicare reimbursement rates in calculating these payments to mitigate disparities due to varying Medicaid reimbursement rates,” the agency said.
HHS announced the application portal for the money back in September, and the $9 billion being distributed this week is part of a $25 billion pot, leaving $16.5 billion left to still give out.
HRSA will make the remaining payments next year.
“While we have made over a half a million relief payments to healthcare providers throughout this pandemic, we know that many continue to face COVID-19 related financial challenges,” said Diana Espinosa, HRSA’s acting administrator, in a statement.
The funding announcement comes less than a month after HHS announced $7.8 billion in relief dollars to rural providers passed as part of the American Rescue Plan Act earlier this year.
Lawmakers have also criticized the slow rollout of the remaining relief funds, especially as providers continue to grapple with surges caused by the virus.
The Trump administration was also criticized last year for doling out the first tranche of relief dollars based on Medicare claims, but advocacy groups criticized the lack of reimbursements to providers reliant on Medicaid. Future tranches of the relief fund made targeted
distributions to providers in COVID-19 hot spots and those reliant on other forms of reimbursement.
To read more, go to Fierce Healthcare.
Many More People Avoiding Care Due to Cost This Year, Survey Shows
By Alex Kacik | December 14, 2021
A growing share of U.S. adults has delayed healthcare this year because they couldn’t afford it, a trend that is driving up treatment costs and worsening patient health.
Thirty percent of Americans skipped care this summer due to cost, up from 18% earlier this year, according to a West Health and Gallup survey. About 1 in 5 said they or a member of their family saw their health deteriorate over the past year as a result. The firms polled 6,663 people in September and October.
Low-income families and people of color have been disproportionately burdened by the COVID-19 pandemic, highlighting unyielding health equity issues. High healthcare costs hit those who can least afford it the hardest. About 2 in 5 Medicaid beneficiaries and those without insurance have seen their health conditions—typically chronic—worsen over the past year after forgoing care.
The financial impact is now expanding to households that make at least $120,000 a year, 20% of which have reported delaying care due to cost over the three months prior to the survey.
As healthcare becomes less affordable and families reach increasing levels of desperation, the velocity of change in the survey results this year has been eye-opening, said Tim Lash, chief strategy officer for West Health.
“Delaying care can be deadly,” Lash said. “But save for significant reform both on the drug side and on the provider-payer side, we’re going to see the number of bodies stack up.”
To read more, go to Modern Healthcare.
ASA Urges United Healthcare to Cover Pain Treatments
December 9, 2021
On December 6, American Society of Anesthesiologists (ASA) and a group of pain medicine societies urged United Healthcare (UHC) to overturn the lack of coverage for two procedures, dorsal root ganglion stimulation (DRG-S) and percutaneous peripheral nerve stimulation (PNS). Despite UHC policy which deems this “medically unnecessary,” both treatments have a proven track record of safety and efficacy.
ASA believes coverage of these neuromodulation treatments is essential. Neuromodulation utilizes therapeutic electrical stimulation of the nervous system and is used by physicians specializing in pain medicine. Overall, these treatments reduce the opioid burden in the chronic pain population and are effective in treating a variety of other painful conditions. ASA strongly supports increased access to non-opioid options for chronic pain patients.
Read letter here.
To read more, go to ASA’s website.
Senate Votes to Avert Medicare Cuts to Providers
By Jessie Hellmann | December 9, 2021
The Senate on Thursday evening voted 59-34 to avert looming Medicare cuts to providers, sending the legislation to President Biden’s desk for signature.
The highly-anticipated vote comes weeks before the cuts were set to take effect, putting providers on edge as lawmakers hammered out a final deal.
The bill, which passed the House earlier this week, will delay 2% cuts to Medicare rates through March 2022 and punt a separate round of 4% Medicare cuts totaling about $36 billion to 2023.
The 2% cuts derive from the 2011 law that created budget sequestration, requiring spending reductions across the federal government beginning in 2013. Congress paused the cuts last year in response to COVID-19. The bill that passed Thursday would keep that pause in place until April 1, after which providers will see a 1% cut until June 30 and a 2% cut until sequestration expires in 2013.
The 4% Medicare cuts are the consequence a budget law known as PAYGO that requires
increases in the deficit be offset by raising revenue or reducing spending. The COVID-19
relief package enacted this year resulted in a larger budget deficit, triggering spending
reductions.
To read more, go to Modern Healthcare.
ASA Urges Agencies to Fix Major Flaw in “No Surprises Act” Regulation
December 8, 2021
On December 6, ASA sent a second formal communication to Biden Administration officials that provided recommendations to ensure the No Surprises Act is implemented fairly and equitably. The letter was sent in response to the second Interim Final Rule (IFR) implementing the No Surprises Act, a bill passed in December 2020 as part of the Consolidated Appropriations Act of 2021 that aims to ensure surprise medical bills (SMBs) are eliminated and that health care payment disputes are handled fairly. The IFR, titled “Requirements Related to Surprise Billing; Part II,” was released in September 2021 as the last of three rules on the No Surprises Act. ASA addressed the recommendations to Secretary of Health and Human Services Xavier Becerra, Secretary of the Treasury Janet Yellen, and Secretary of Labor Marty Walsh, leaders of the federal agencies responsible for issuing regulations to implement this legislation.
A major focus of ASA’s comments was centered on correcting the weighting of the Independent Dispute Resolution (IDR) factors. ASA urged the relevant federal agencies to ensure that all factors are considered equally in IDR and that the Departments should convey the limitations of the QPA to IDR entities. Congress clearly intended for each factor to play a role in the arbiter’s decision when it stated that arbiters “shall consider” the QPA and “information on any circumstance” described in the statute as requested by the IDR entity or submitted by a party. Despite this directive, the Departments added new restrictions that severely limit the scope of what an arbiter can assess and rather designed an IDR process that heavily favors health insurance companies in payment disputes by directing the arbiter to give the highest priority to the insurer-calculated median in-network amount over other considerations and arguments presented by physicians.
ASA also recommended that, to ensure the law is implemented fairly, arbiters be selected based on their experience with physician payments in the applicable geographic region and not based on prior decisions. Furthermore, ASA urged the Departments to disapprove arbiter fees that exceed the fixed fee ranges to ensure that arbiter costs are reasonable and will not be used to dissuade smaller provider groups from seeking resolution.
In regard to anesthesia services specifically, ASA further urged the Departments to allow all disputed anesthesia services to be batched in one determination, regardless of the associated procedure. Unlike other specialties, payments for anesthesia procedures, whether cardio-thoracic or orthopedic, are based on the same conversion factor, and only the conversion factor is subject to dispute resolution; batching such claims in one determination will help promote system efficiencies.
Read ASA Comment Letter.
To read more, go to ASA’s Website.
Interim Results from Survey on ACGME Requirements
December 2, 2021
In our June issue, we ran a letter from John G. Brock-Utne, MD, PhD; James McAvoy, MD; and Richard A. Jaffe, MD, PhD, which asked, “Are ACGME Requirements Failing Our Anesthesiology Residents?” (2021;47[6]:4). As part of that commentary, they introduced a survey that asked just four questions, which readers could answer—and still can, at https://www.surveymonkey.com/ r/ MN7CTT9 .
To see results so far, go to Anesthesiology News.
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