|National Healthcare Spending Grows 2.7% as COVID-19 Relief Runs Dry|
By Jacqueline LaPointe | December 15, 2022
National healthcare spending is slowing down in the US compared to a significant 10.3 percent increase in 2020. However, healthcare costs remain high as US health expenditures reach $4.3 trillion.
Healthcare spending now accounts for 18.3 percent of the US’ gross domestic product (GDP), a percentage lower than 19.7 percent in 2020 but still higher than 17.6 percent in 2019.
The data released by CMS actuaries earlier this week was part of the National Health Expenditures (NHE) report. The NHE report is published annually and measures total annual spending by the delivery of healthcare goods and services (e.g., hospital, physician, and prescription drugs), type of payer (e.g., commercial health insurance, Medicare, and Medicaid), and type of sponsor (e.g., businesses, households, and federal/state governments).
The 2021 NHE Report showed that healthcare spending in the US grew by 2.7 percent last year as the federal government provided less financial support to healthcare providers to offset losses and added expenses from the COVID-19 pandemic.
The federal government spent 3.5 percent less on healthcare in 2021, as Provider Relief Fund and Paycheck Protection Program (PPP) funds, which assisted businesses with payroll, increased expenses, and lost revenue due to the pandemic, dried up. Federal public health activity also declined while there was slower growth in the federal portion of Medicaid payments, according to the report.
Lower federal spending on healthcare more than offset the impact of greater healthcare utilization and insurance coverage that year, CMS stated.
Spending on hospital and physician services slowed relative to 2020. Hospital care spending increased by 4.4 percent in 2021 compared to 6.2 percent growth in 2020. In total, spending on hospital services reached $1.3 trillion.
To read more, go to Revcycle Intelligence.
ASA Joins with Critical Care Medicine Organizations to Urge House Leadership to Stop All Medicare Payment Cuts
December 14, 2022
ASA has joined the Society of Critical Care Anesthesiologists (SOCCA), and the Society of Critical Care Medicine (SCCM) in a formal communication to the leadership of the U.S. House of Representatives urging immediate action to stop pending Medicare physician payment cuts to critical care services and the services of other physicians. The letter notes that critical care physicians have been on the front-lines of the COVID-19 pandemic and that economic support for their services is essential to ensuring appropriate patient access to important intensive care services.
The organizations called on Congress to block all pending payment cuts. Without congressional action, the cuts will be effective January 1, 2023.
To read more go to ASA’s website.
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AMA, Medical Societies Decry Pending Medicare Cuts
By Jeff Lagasse | December 12, 2022
In a letter to congressional leaders, the American Medical Association and every state medical society are telling Congress that any cut to Medicare payments will “undermine Medicare’s ability to deliver on its promises to seniors.”
What the groups want from Congress is action that would avert the entire 4.5% reduction to Medicare payment rates from being implemented on January 1, 2023. This relief, the AMA said, will help provide short-term financial stability for practices until permanent, bipartisan payment reforms are enacted.
Congress has until January 1 to avoid the cuts, which the medical groups stressed would prove harmful to seniors seeking healthcare.
“We cannot overstate the importance of Congress stopping the entirety of the upcoming 4.5% reduction,” according to the letter, which was signed by all 50 state medical societies, as well as Washington, D.C.
WHAT’S THE IMPACT?
The impending 4.5% Medicare Physician Fee Schedule (MPFS) payment cut comes as medical practices throughout the country are experiencing pressures stemming from rising rates of inflation, according to the letter.
While all healthcare stakeholders struggle with steep annual payment reductions, they’re exacerbated by the fact that physicians are the only providers whose Medicare payments do not automatically receive an annual inflationary update, the AMA said. This statutory flaw that characterizes the MPFS consistently leads to financial uncertainty and budgetary challenges for all physicians, according to the group.
“The stark reality is that, adjusted for inflation in practice costs, Medicare physician pay has declined 22% from 2001 to 2021,” the letter read. “Allowing cuts to Medicare payments is simply unacceptable during this time of record inflation and coming on the heels of a highly disruptive pandemic.”
The group contended that this contributes to burnout, stress, workload and the cumulative impact of the COVID-19 pandemic, which has one in five physicians considering leaving their practice within the next two years. The payment cuts, the AMA said, will only accelerate this trend unless the reduction is stopped in full; otherwise, it’s likely that Medicare patients will struggle to access healthcare services.
“Put simply, the cost of congressional inaction is an across-the-board cut that will further amplify the financial hardship physician practices are already facing while inhibiting Medicare from delivering on its promises to seniors and future generations,” according to the letter.
THE LARGER TREND
The 2023 Medicare Physician Fee Schedule final rule reflects the end of the temporary 3% supplemental increase from 2022. Physician groups are pressing for Congress to intervene to stop the cuts. Many are pushing for Congress to pass the Supporting Medicare Providers Act, H.R. 8800. Combined with a 4% Medicare cut stemming from the Statutory Pay-As-You-Go Act, physicians said they are looking at a nearly 8.5% Medicare cut on January 1.
To read more, go to Healthcare Finance.
6 Things to Know About the 1st Year of the No Surprises Act
By Rylee Wilson | December 6, 2022
The No Surprises Act, which protects consumers from out-of-network charges for emergency care and other services, took effect Jan. 1 of this year.
While data shows the new policy is saving patients money, questions and lawsuits over how disputes about bills will be resolved between payers and providers abound.
Here are six developments Becker’s has reported in the act’s first year in effect.
Payers say the act has saved consumers money A report from AHIP and the Blue Cross Blue Shield Association found the bill has saved 9 million patients from surprise medical bills since January. A separate study found the act could result in 3 million more emergency room visits each year, because individuals no longer fear catastrophic bills.
CMSissued a final rule on how disputes between payers and providers over out-of-network rates will be solved in August In November, the House Ways and Means Committee called the rule “seriously disappointing.” Critics have argued the rule gives too much power to payers.
Disputes have centered on the arbitration processThe Texas Medical Association filed its third lawsuit challenging the act on November 30. In a news release, the association said it was challenging rules that “skew negotiations in favor of health insurers so strongly that health insurers will force physicians out of insurance networks and physicians will face significant practice viability challenges, struggling to keep their doors open in the wake of the pandemic.”
The Texas Medical Association filed its first No Surprises Act lawsuit in October 2021, successfully arguing that requiring arbitrators to heavily weigh figures created by insurers conflicted with the law and provided insurers with an unfair advantage unintended by Congress.
The group filed a second lawsuit in September, arguing the final rule “unfairly advantage[s] health insurers by requiring arbitrators to give outsized weight or consideration to the [qualifying payment amount].” A hearing in that case is scheduled for Dec. 20.
Many provider organizations have backed the Texas Medical Association’s challengesIn October, the American Hospital Association and the American Medical Association, along with 30 additional national and state medical groups, filed amicus briefs supporting the Texas Medical Association’s second lawsuit.
Payers have backed HHS’ ruleAHIP filed an amicus brief Nov. 16 in Texas Medical Association v. HHS. The association says the arbitration rule does not give payers the upper hand. In a press release, the trade association said there is “no basis” to providers’ claims that the arbitration rates will cause payers to lower reimbursement rates and narrow networks.
There is a lengthy backlog of claimsHHS has received more than 90,000 claims since launching the independent dispute resolution portal in April.
To read more, go to Becker’s Payer Issues.
HHS Gives Providers More Time for Good Faith Estimate Compliance
By Jacqueline LaPointe | December 6, 2022
HHS has extended enforcement discretion for the delivery of some good faith estimates (GFEs) under the No Surprises Act, according to new guidance.
The guidance released by HHS on Friday says that CMS will not begin enforcing the No Surprises Act requirement that healthcare providers deliver GFEs to uninsured and self-pay individuals when there are co-providers or co-facilities. Enforcement of the No Surprises Act requirement was slated to start on Jan. 1, 2023. Instead, HHS is holding off on enforcement until future rulemaking.
GFEs are price estimates for any item or service that is reasonably expected to occur during a scheduled procedure or requested item or service. The estimates include any items or services that may involve providers or facilities outside of the one scheduling the service. These co-providers and co-facilities, as they are named in the regulations, must submit GFE information within one business day of a convening provider’s request.
However, industry groups have expressed concerns about getting GFEs, including co-provider and/or co-facility price estimates, to patients within the statutory timeframe, which is three days after an individual requests the price estimate or after the service is scheduled. The groups have cited administrative burden and data exchange limitations as reasons why HHS should modify or revisit GFE requirements.
“By extending this exercise of enforcement discretion, HHS aims to promote further interoperability across the [healthcare] industry and encourage providers, facilities, and other industry members to focus resources towards adopting interoperable processes for exchanging information,” the guidance states.
HHS believes that healthcare providers and facilities will need to widely adopt “a standards-based application programming interface (API)” in order to “achieve industry-wide interoperability for the transmission of GFE data between convening providers and facilities and co-providers and co-facilities.” The Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) standard could support the interoperability providers need to deliver full GFEs to individuals, the federal department adds.
“The industry continues to make progress in developing data interchange standards to support the requirements of the No Surprises Act,” Charles Stellar, president and CEO of the Workgroup for Electronic Data Interchange (WEDI), said in a statement.
To read more, go to Revcycle Intelligence.
18 Million Could Lose Medicaid Coverage At End of PHE, New Estimates Show
By Andrew Cass | December 6, 2022
Updated estimates from the Urban Institute and Robert Wood Johnson Foundation show that 18 million people could lose Medicaid coverage when the COVID-19 public health emergency ends.
Six things to know:
The estimates in the Dec. 5 report are up 2 million from a March 9 analysis, which projected 16 million could lose coverage at the end of the public health emergency. The new report states that while many who are currently enrolled in Medicaid will transition to other coverage options, 3.8 million will become uninsured. Nineteen states will see their uninsured rates spike by more than 20 percent Of the 3.8 million who will become uninsured, about 1.5 million will be eligible for Marketplace premium tax credits, but will not enroll. An estimated 3.2 million children will transition from Medicaid to separate Children’s Health Insurance Program plans.State policy determination during the transition following the public health emergency declaration will have a “crucial impact on how many people lose coverage, how rapidly they lose it, and how many people enroll in other coverage,” Matthew Buettgens, senior fellow at the Urban Institute, said in a news release shared with Becker’s. To read more, got to Becker’s Payer Issues.
2021 Quality Payment Program Performance Information Preview Now Available
December 5, 2022
The Centers for Medicare & Medicaid Services (CMS) has opened access for physicians and other clinicians to view their 2021 Quality Payment Program (QPP) performance data in a month-long Preview Period ending on December 20, 2022 at 8 p.m. ET. This period allows eligible clinicians (ECs) to review their performance data and profile information on the QQP website before it becomes publicly available on Medicare Care Compare and in the Provider Data Catalog (PDC).
ASA recommends that eligible clinicians review their profiles and metrics to check for discrepancies before the Preview Period closes. Any errors should be reported to the QPP Service Center at 1-866-288-8292 (Monday-Friday 8 a.m. – 8 p.m. ET) or by e-mail at QPP@cms.hhs.gov.
Accountable Care Organization (ACO)-level data is not available during this preview period. However, ECs participating in an ACO can review their quality performance in the 2021 Merit-based Incentive Payment System (MIPS) Performance Feedback Reports.
To read more, go to ASA’s website.
Texas Medical Association Files Another Lawsuit Against No Surprises Act
By Susan Morse | December 1, 2022
The Texas Medical Association has filed its third lawsuit against the No Surprises Act.
The complaint was made Wednesday by the TMA and Tyler Regional Hospital in Texas in the U.S. District Court for the Eastern District of Texas. It is against the Department of Health and Human Services, which released the rule; the Department of Labor; and the Department of the Treasury.
The lawsuit challenges certain portions of implementation of the July 2021 interim final rule. Specifically, the TMA and Tyler Regional Hospital allege that the rules “artificially deflate” the Qualifying Payment Amount, an insurer-calculated amount used in arbitration when deciding the appropriate out-of-network rate presented by physicians and insurers.
The system is rigged against doctors and in favor of the insurer, the TMA said by statement. The TMA and health system want a declaration that the federal departments acted unlawfully and vacate provisions of the July rule.
WHY THIS MATTERS
While the Qualifying Payment Amount is supposed to be the median in-network rate, the methodology conflicts with the way that the No Surprises Act requires insurers to calculate the payment amount, the TMA said. Physicians have the scales tipped against them from the outset of negotiations, TMA president Dr. Gary W. Floyd said. There is also a lack of transparency, he said.
“TMA is concerned that these provisions unfairly disadvantage physicians in payment disputes with health insurers and will ultimately rob patients access to physicians’ care,” Floyd said.
The rule allows insurers to include “ghost rates” in their QPA calculations. These are contract rates with physicians and providers who don’t actually provide the health service in question, the TMA said. Because there is little motivation for those not providing the service to negotiate rates, this lowers the rates for the providers who actually provide the services.
The TMA contends that the rule allows insurers to use the rates of physicians who are not in the same or a similar specialty. It also says that the rule requires insurers to use an amount other than the total payment in calculating QPA when a contract includes risk sharing, bonus or penalty or other incentive-based adjustments.
Also, self-insured plans are able to opt in to a lower QPA, the TMA said.
To read more, go to Healthcare Finance.