Insurers Estimate No Surprises Act Blocked 2M Bills In Two Months
By Lauren Berryman | May 24, 2022
The No Surprises Act shielded private health insurance enrollees from an estimated 2 million surprise bills during the first two months of the year, according to a report health insurance industry groups released Tuesday.
AHIP and the Blue Cross Blue Shield Association surveyed more than 80 commercial health insurance companies, 31 of which responded. Those insurers represent 115 million commercial health plan members.
These companies reported receiving 600,000 claims covered by the surprise billing law in January and February. Based on claims experiences from prior years and factoring in processing delays this year, the insurance groups estimate that the true amount of such bills at 2 million.
AHIP and the Blue Cross Blue Shield Association project the new rules could prevent more than 12 million surprise bills this year.
Before President Donald Trump enacted the No Surprises Act in 2020, two-thirds of adults reported feeling worried about whether they could afford surprise medical bills, according to a Kaiser Family Foundation survey.
The law, which took effect Jan. 1, aims to protects patients from unforeseen medical bills, including those issued by out-of-network health professionals working at in-network facilities. Regulations implementing the statute require independent dispute resolutions to resolve billing disputes between insurers and providers without patients needing to be involved.
Payers and providers have battled over the particulars of that process as each side seeks to defend its financial interests.
“The law is working to protect millions of consumers from costly surprise bills and yet several hospital and provider organizations have filed lawsuits challenging the [No Surprises Act] regulations and legislation in order to increase their own profits at patients’ expense,” the insurance groups’ report says.
To read more, go to Modern Healthcare.
Payments to Anesthesia Practitioners Higher in Physician Practice Groups
May 23, 2022
Payments to anesthesiologists increased after hospital outpatient departments and ambulatory surgery centers contracted with a physician management company (PMC), and were significantly higher if the PMC received private equity (PE) investment, according to a retrospective study. The study appeared in JAMA Internal Medicine.
“There have been significant changes in the ownership and organization of physician practices over the past decade,” said lead author Ambar La Forgia, PhD, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health, in New York City. “We have seen vertical integration between hospitals and physicians, horizontal mergers leading to physician mega-groups, and newer models of delivery, such as concierge medicine.”
Amid this consolidation, PMCs and PE firms have become prominent owners of physician practices, according to La Forgia. “Despite this trend, there has been little empirical research on how these entities influence healthcare outcomes,” she said.
Reimbursable Amounts Increase
For the study, commercial claims data from three large national insurers in the Health Care Cost Institute database, for 2012 to 2017, were combined with a novel database of PMC facility contracts to identify prices paid to anesthesia practitioners in outpatient facilities.
To read more, go to Anesthesiology News.
Employer Health Plans Pay Hospitals 224% of Medicare
By Alex Kacik | May 17, 2022
Employers continue to pay hospitals more than double the amount Medicare would pay for the same services, a new study shows.
Private employer-sponsored health plans paid hospitals 224% of Medicare prices, on average, according to an updated RAND Corp. analysis of claims from 4,000 hospitals across every state except Maryland. Hospitals with higher market shares tended to have higher prices, according to the study, which supports past research.
A 10% increase in hospital market share was associated with a 0.5% increase in a hospital’s price relative to Medicare, researchers found. Still, some researchers noted that a 0.5% increase for a significant 10% boost in market share was relatively small.
“No one expects prices to go down year over year given how consolidated most hospital markets are,” said Glenn Melnick, a health economist and policy professor at the University of Southern California, whose work shows that prices tend to increase as hospitals grow. “My prediction is that once the study is updated again, prices are going to shoot up. The wage push and cost pressure on these facilities is enormous, so they are going to pass it on.”
Private insurers paid 222% of Medicare prices in 2018 and 235% in 2019. The 224% total for 2020 was less than the 247% figure reported for 2018 because the sample size increased with data from states like Washington, Oregon and Utah where hospitals tend to have lower prices, the researchers noted.
That decline was telling, said Rick Pollack, president and CEO of the American Hospital Association.
“This suggests what we have long suspected: You simply cannot draw credible conclusions from such a limited and biased set of claims,” he said in a statement.
Hospitals also claim that Medicare does not fully cover the cost of care for Medicare beneficiaries. Relying solely on Medicare rates would likely cause hospitals to cut services, which would reduce access to care, Pollack said.
That implies that hospitals shift costs, meaning they charge higher rates for their commercially insured patients to make up for the relatively lower pay for care provided to Medicare and Medicaid beneficiaries and the uninsured. But RAND researchers did not find evidence to support the cost-shifting premise.
Medicare, in part, bases its payment levels on hospitals’ labor costs. Medicare may boost its rates in 2022 and 2023 to account for the average 13% increase in hospitals’ wage and benefit expenses from October 2020 to October 2021, industry observers said.
“We know that Medicare rates have not increased much, and as my Brookings Institution colleagues have pointed out, they may go up in 2022 or 2023,” said Paul Ginsburg, a health policy professor at USC and senior fellow of the USC Schaeffer Center for Health Policy and Economics. “It might be a temporary change allowing higher wages to factor into the Medicare input price data.”
To read more, go to Modern Healthcare.
US Set to Extend COVID-19 Public Health Emergency Past July
By Riley Griffin | May 16, 2022
The US government will extend the Covid-19 public-health emergency past mid-July, continuing pandemic-era policies as the nearly 2 1/2-year outbreak drags on.
The Department of Health and Human Services has repeatedly renewed the public-health emergency since implementing it in January 2020. The declaration allows the US to grant emergency authorizations of drugs, vaccines and other medical countermeasures, as well as administer those products to millions of people at no out-of-pocket cost. It’s also enabled millions of Americans to get health coverage through Medicaid, among other benefits.
On April 16, HHS extended the public-health emergency an additional 90 days through mid-July. The declaration will be extended beyond that period, according to a person familiar with the matter, who asked not to be identified because the details aren’t public. That means various measures to relax restrictions in how care is accessed across the health system will continue.
An HHS spokesperson said the public-health emergency remains in effect, and the department will continue to provide a 60-day notice to states before any possible termination or expiration.
To read more, go to Bloomberg news.
Payment Dispute Process Begins for Out-of-network Anesthesia Services: 3 Things to Know
By Riz Hatton | May 13, 2022
The independent dispute resolution process for out-of-network services is now available to anesthesiologists and other healthcare providers.
CMS opened the independent dispute resolution process for healthcare providers to resolve out-of-network payment disputes April 15.
Three things to know about the independent dispute resolution process:
To read more, go to Becker’s ASC Review.
Nurse Workforce Shortage Looms as More Nurses May Leave Profession
By Victoria Bailey | May 11, 2022
While nursing salaries have increased, the share of nurses considering leaving the profession is also up as pandemic-related stressors continue to impact the workplace and exacerbate the nurse workforce shortage, the 2022 Nurse Salary Research Report found.
The report assesses salary, benefits, education, and pandemic impacts for registered nurses (RNs), advanced practice registered nurses (APRNs), and licensed practical/vocational nurses (LPNs/LVNs). Nurse.com surveyed more than 2,500 nurses between November 12 and December 12, 2021.
The median salary for RNs was $78,000, marking a substantial increase from the 2020 median of $73,000. APRN salary was up $13,000 in 2021 at $120,000 and LPN/LVN was $3,000 higher at $48,000.
However, the gender pay gap for RNs widened, with male RNs making $14,000 more per year than females. In contrast, female APRNs and LPN/LVNs had slightly higher salaries than their male counterparts.
Racial disparities in salary also emerged. Nurses who identified as Black or African American and American Indian or Alaska Native reported the lowest levels of satisfaction with their salaries and reported working more hours per week than other racial groups.
Unsurprisingly, the COVID-19 pandemic significantly impacted the healthcare workforce, though not all of the effects were negative.
For example, when asked if the pandemic affected their salaries, 25 percent of respondents noted increases in their pay. RNs were more likely to report gains compared to APRNs, but LPN/LVNs were more likely to report increases than both RNs and APRNs.
Nurses between 25 and 44 years old, male nurses, acute care and long-term care nurses, Black nurses, and Native Hawaiian or other Pacific Islander nurses were also more likely to report pandemic-related increases in their salaries.
The pandemic made some nurses reassess their positions, though. The percentage of nurses considering changing employers rose from 11 percent in 2020 to 17 percent in 2021.
To read more, go to Revcycle Intelligence.
CMS Releases Chronic Pain Experience Journey Map as Part of HHS Overdose Prevention Strategy
May 7, 2022
On May 6, the Centers for Medicare & Medicaid Services (CMS) released a new Chronic Pain Experience Journey Map which was developed to highlight the barriers to care experienced by chronic pain patients, how these barriers impact their quality of care and quality of life, and the various influences on providers. The map is one component of the Administration’s broader overdose prevention strategy, aligning with important provisions of ASA-supported legislation, the SUPPORT for Patients and Communities Act. This work leverages input from stakeholders and other federal agencies to implement the Dr. Todd Graham Pain Management Study Act, in which ASA was pleased to submit formal comments to CMS and weigh-in with the Centers for Disease Control and Prevention (CDC) on barriers to care, Medicare coverage, issues specific to beneficiaries with substance use disorders (SUD), and pain care during the COVID-19 pandemic.
The map utilizes qualitative research methods and human-centered design process to visualize the experiences of living with, providing care for, and treating patients with chronic pain.
ASA is pleased CMS is prioritizing various perspectives on experiences with pain and pain management and applauds the efforts to understand more about access to covered care and services for people with chronic pain.
View the Journey Map here.
To read more, go to ASA’s website.
End of Relief Aid Pressures Safety-net Hospitals, Uninsured
By Marissa Plescia | May 2, 2022
The ending of federal program funds for COVID-19 relief is threatening uninsured patients who delayed care, as well as financially struggling safety-net hospitals that provide uncompensated care, The New York Times reported May 1.
Relief funds created something similar to a “universal coverage system within a system” that provided coverage to everyone with the virus, John Graves, health policy professor at Vanderbilt University School of Medicine, told the Times. The Provider Relief Fund gave hospitals tens of billions of direct funding, while the COVID-19 Uninsured Program gave more than $20 billion in reimbursements to about 50,000 hospitals, clinics and other providers.
Although COVID-19 hospitalizations are tapering off, safety-net hospitals are getting an influx of patients who delayed care for chronic conditions and other health problems that worsened over time and have become more complicated to treat.
The issue is especially challenging in Tennessee, which has one of the highest rates of hospital closures in the U.S. and has not expanded Medicaid, according to the Times. About 300,000 people are in the “coverage gap” and are ineligible for Medicaid or discounted health insurance but have little to no income.
To read more, go to Becker’s Hospital Review.