Insurers to Get a Break on Price Transparency, Surprise Billing
By Michael Brady | August 24, 2021
Health plans will have more time to get ready for several requirements under the insurer price transparency rule and the ban on surprise billing, according to federal guidance published last week.
The Biden administration won’t crack down on insurers for failing to publish machine-readable files of provider rates until July 1, even though the requirement takes effect at the start of next year. But that doesn’t mean they’re going away.
“The administration and Congress have indicated broad support for policies that provide more transparency into healthcare costs,” said Myra Simon, a consultant at Avalere Health.
The guidance also indefinitely delayed enforcement of a similar requirement for prescription drug pricing. The Biden administration is reconsidering whether the policy still makes sense in light of the new prescription drug reporting requirements that Congress included in its end-of-year spending packing last December.
Health plans were supposed to start reporting that information at the end of the year, but regulators are giving health plans a break. There’s no firm deadline for reporting data on prescription drug prices. But the Biden administration will probably ask for both 2020 and 2021 data in December 2022, McDermott Will & Emery partner Kate McDonald said.
Coordinating the Trump-era transparency rule with the new mandates from Congress would make it easier and less costly for insurers to report the prescription drug pricing information. But it shouldn’t harm transparency, Simon said.
To read more, go to Modern Healthcare.
ASA Opposes AANA’s Misleading Organizational Name Change
August 19, 2021
On August 14th, the American Association of Nurse Anesthetists (AANA) publicly changed its name to the “American Association of Nurse Anesthesiology”. ASA believes this name change combined with AANA’s continued encouragement of their members to use the term “nurse anesthesiologist” is a clear pattern of medical title misappropriation that confuses patients and creates discord in the care setting, ultimately risking patient safety.
ASA’s concerns about this title misappropriation are centered around the long-held medical ethics standard that patients have a right to know the education and qualifications of the professionals providing their care. In this spirit, the term “anesthesiologist” has been used to differentiate physicians who’ve completed the highest level of training in anesthesia care from non-physicians, including nurse anesthetists.
ASA recently authored an open letter asking nurse anesthetists to reject the AANA’s use of the “nurse anesthesiologist” title. ASA will continue to foster a strong relationship between anesthesiologists and nurse anesthetists in their collaborative mission to provide the best care for their patients while challenging any attempt to sow confusion in the identification of roles or advance nurse-only care.
Senate Passes Infrastructure Deal with Medicare Savings and Drug Shortage Provisions
August 12, 2021
This week, the Senate passed a wide-ranging infrastructure package with bipartisan support. The $1.2 trillion bill is aimed at rebuilding roads and bridges, installing broadband, and funding climate resilience initiatives, among other infrastructure priorities. This legislation extends Medicare payment cuts in future years as a source of funding for the infrastructure package.
The package would extend a 2% cut to all Medicare payments to providers to 2031. This payment cut was implemented as part of sequestration, but was paused due to the COVID-19 pandemic; ASA has worked to advance legislation to avoid payment cuts.
Another provision in the bill allows the Department of Health and Humans Services (HHS) to collect a rebate from drug manufacturers on 100% of waste above a 10% low volume threshold for vials of Medicare Part B medications. This measure aims to reduce costs for patients and payers by incentivizing drugmakers to phase out high-volume, single-use drug containers with more doses than needed by patients. ASA has long supported addressing vial sizes and drug waste and commends Congress for the inclusion of this language.
ASA will continue to monitor the infrastructure package as it advances to the House of Representatives and will provide updates if any changes relevant to our members are added to the bill.
To read more, go to ASA’s website.
ZOOM Launches Telehealth Mobile Browser
By John Commins | August 10, 2021
Online video conferencing provider Zoom announced this week that it is launching a mobile browser that will allow users to join secure telehealth appointments without downloading the app.
The new feature is designed for infrequent users of telehealth or people who may not be tech savvy, according to a post on Zoom’s website.
“Everyone needs healthcare, but not everyone uses technology all the time,” Zoom said. “Some patients unfamiliar with how to download an app may have to spend time on the phone with their doctor’s office to get assistance — which isn’t very convenient if you’re sick and trying to access care. Others may only use Zoom to connect with their doctor once or twice a year and may not want to download an app for that.”
The mobile browser allows patients to receive a Zoom meeting link from their provider via text or email. When the appointment begins, patients simply clink the link and follow the prompts to launch the meeting on their mobile device.
Patients seeking telehealth access on their desktop or laptop computer can join Zoom meetings directly from a web browser, where they click the link and follow the prompts.
Zoom says the mobile browser will also make life easier for providers by streamlining the process, eliminating the need to download an app, and reducing time spent with tech support.
While patients using the browser will have a simplified user interface that is easy to use, providers will get all the benefits of a Zoom app call, including meeting host controls and virtual background. The browser also allows patients more flexibility to schedule appointments from anywhere, as opposed to being chained to a desktop.
In addition, providers can schedule appointments with a feature that simulates a traditional clinical workflow.
To read more, go to Health Leaders Media.
CMS Releases 2020 MIPS Performance Scores, Instructions on Appealing
August 5, 2021
The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for performance year 2020 and associated MIPS payment adjustment information for payment year 2022. The payment adjustment is a positive, negative, or neutral payment adjustment applied to the eligible clinician (EC) or group’s Medicare paid amount for covered professional services furnished in 2022.
ECs and groups can view their MIPS performance feedback, final score, and 2022 payment adjustment on the Quality Payment Program (QPP) website. Once on this website, ECs and groups should use their HCQIS Access Roles and Profile (HARP) system credentials. ECs and groups that do not have a HARP account should refer to the Register for a HARP Account and Connect to an Organization documents in the QPP Access User Guide.
MIPS ECs and groups, including APM participants, may request that CMS review the calculation of their MIPS payment adjustment factor(s) through a process called targeted review. If an EC or group believes an error has been made in the calculation of their MIPS payment adjustment factor(s), they may request a targeted review until October 1, 2021. Some examples of previous targeted review circumstances include the following:
Data was submitted under the wrong Taxpayer Identification Number (TIN) or National Provider Identifier (NPI);
• Eligibility and special status issues (e.g., the EC or group fell below the low-volume threshold and shouldn’t receive a payment adjustment);
• Performance categories weren’t automatically reweighted even though the EC or group qualified for reweighting due to extreme and uncontrollable circumstances.
ECs and groups can request a targeted review by going to the QPP website.
CMS generally requires documentation to support a targeted review request, which varies by circumstance. Once submitted, the EC or group will be contacted by a representative with information about any specific documentation required. If the targeted review request is approved and results in a scoring change, CMS will update your final score and/or associated payment adjustment (if applicable), as soon as technically feasible. Targeted review decisions are final and not eligible for further review.
To read more, go to ASA’s website.
ASA, APSF Call for COVID-19 Testing for Elective Surgery Regardless of Vaccine Status
August 5, 2021
The American Society of Anesthesiologists (ASA) and Anesthesia Patient Safety Foundation (APSF) released new guidance urging the reinstatement of the practice to use preoperative polymerase chain reaction testing for SARS-CoV-2 in all patients undergoing nonemergency surgeries or procedures, even in those who are fully vaccinated, according to a release from the societies.
“Considering the ongoing and evolving pandemic, all patients undergoing an anesthetic, procedure, or surgery with the potential to generate aerosols should continue to have preoperative testing for SARS-CoV-2, ideally within three days prior to the procedure,” said Beverly K. Philip, MD, the president of the ASA. “This is a critical safety measure, considering that fully vaccinated individuals, symptomatic or asymptomatic, have the potential to transmit the virus. The updated joint guidance on testing and screening will help surgeons and proceduralists, working together with physician anesthesiologists, to better evaluate and schedule patients.”
The statement comes in the wake of increases in COVID-19 cases across the United States, largely related to the prevalence of the Delta variant, as reported by the CDC. The ASA and APSF emphasized the seriousness of the CDC’s report on the Delta variant—especially the discovery of breakthrough infections in fully vaccinated individuals—as the reason for the updated guidance.
The statement acknowledged that many institutions have continued testing all patients for COVID-19 in recent months. It also included a detailed review of best practices for testing and managing patients in the preoperative screening process.
To read more, go to Anesthesiology News.
Higher ACA Subsidies Are Saving Consumers A Lot of Money
By Michael Brady | August 4, 2021
Consumers who buy health insurance through the Affordable Care Act’s exchange marketplaces have saved 40% on monthly premiums since new tax credits took effect in April, CMS reported Wednesday.
More than one in three shoppers found coverage for $10 or less per month through HealthCare.gov, which is the federal enrollment portal used in 37 states. Another 2.5 million federal exchange enrollees saved at least $40 on their premiums since President Joe Biden’s administration opened a special enrollment period in February as part of its COVID-19 response. The CMS report doesn’t include information from the exchanges operated by 14 states and the District of Columbia.
“Americans who need health coverage should act now. This is your opportunity to find quality, affordable health coverage that will protect you and the health of your family into the future. Please go to HealthCare.gov to enroll in a comprehensive plan that is affordable,” CMS Administrator Chiquita Brooks-LaSure said in a news release.
Congress temporarily increased subsidies for plans purchased through Affordable Care Act marketplaces in the American Rescue Plan, the $1.9 trillion COVID-19 relief package enacted in March. But that extra financial assistance is set to expire after 2022, which could give policyholders sticker shock if their premiums skyrocket the following year.
Biden wants to make sure that doesn’t happen, so he’s working with Democrats to extend the subsidies beyond next year.
To read more, go to Modern Healthcare.
Small Business Administration Opens Paycheck Protection Program Direct Forgiveness Portal Designed to Provide Reprieve to Small Businesses
August 3, 2021
Recently, the Small Business Administration (SBA) launched a streamlined application portal that allows businesses and not-for-profits with Paycheck Protection Program (PPP) loans of $150,000 or less through participating lenders to apply for forgiveness directly through the SBA. The process for loan forgiveness is outlined by SBA on their website.
The new interim final rule clarifies those small businesses that are currently waiting for an appeal decision regarding eligibility for loan forgiveness from the SBA’s Office of Hearings and Appeals can defer payment on their loans, providing reprieve to many small businesses.
The CARES Act, passed in March 2020, established the Paycheck Protection Program (PPP). PPP loans are designed to help small businesses avoid closure or layoffs, and can be used to cover payroll, utilities, insurance premiums, and rent and mortgage interest payments on a facility. This program closed August 8, 2020 and SBA is no longer accepting PPP applications from participating lenders.
How Policy, Regulation Will Challenge Consolidation in Healthcare
By Jaqueline LaPointe | August 3, 2021
Healthcare mergers and acquisitions have promised to bring lower costs, higher quality, and better access to care. But a new executive order is challenging the rapid pace of consolidation in healthcare, directing policy and regulation to put a chill on deals the administration feels are harmful to patients.
The “Executive Order on Promoting Competition in the American Economy” aims to bolster competition across industries. However, the Biden-Harris Administration specifically called out consolidation in healthcare, with a fact sheet saying the order “[u]nderscores that hospital mergers can be harmful to patients and encourages the Justice Department and FTC to review and revise their merger guidelines to ensure patients are not harmed by such mergers.”
The executive order also provided instructions for other agencies to address consolidation among other healthcare organizations, including pharmaceutical companies and payers, through future policy and regulation.
On first glance, the executive order may seem a little too late for an industry that is already highly consolidated in many areas. One study from 2019 found that nearly three-quarters of metropolitan areas have highly concentrated hospital markets and the rate of hospital mergers and acquisitions has not slowed since then despite a global pandemic.
However, the executive order has some serious implications for healthcare organizations—and not just hospitals and health systems—looking to join forces with others in their market. RevCycleIntelligence spoke with industry experts to learn what healthcare leaders need to know about the executive order and how it will impact consolidation in healthcare moving forward.
To read more, go to Revcycle Intelligence.