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.
Hospital System Sues Insurer for $1B Over Losses From Imaging, Other Tests During COVID-19
By Matt O’Connor | August 3, 2021
Pittsburgh-based Allegheny Health Network is suing its insurer for breach of contract over losses it incurred following the COVID-19 shutdown of nonemergency services, including imaging and other tests, last year.
The 14-hospital system is joined by dozens of physician practices, surgical affiliates, and hospitals in the four-count civil lawsuit against American Guarantee and Liability Insurance Co., the Pittsburgh Post-Gazette reported Aug. 3.
The lawsuit, first filed in June, alleges the Schaumburg, Illinois-based insurer refused to pay upwards of $100,000 for losses “well in excess of $250,000” after the state shut down services last year to curb COVID-19 from spreading. The move severely reduced patient traffic, resulting in “catastrophic” losses, according to the news outlet.
AHN’s policy covers business interruption losses caused by a communicable disease up to $1 billion, the lawsuit states. The health system’s motion to move the case from the Court of Common Pleas of Allegheny County to its Commerce and Complex Litigation Center is scheduled for Thursday.
“COVID-19, a communicable disease, directly impacted AHN’s business,” the lawsuit states, according to the Gazette. “The business loss caused by COVID-19 has had a catastrophic impact on AH N’s various insured locations and its business operations.”
Read the full story below: Allegheny Health Network sues insurer for COVID-19 losses
To read more, go to Health Imaging.
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.
Radiologists Express ‘Serious Concerns’ With New National Practice Standards Superseding State Laws
By Marty Stempniak | August 02, 2021
Radiologists and other physicians are expressing “serious concerns” with efforts to develop national practice standards for docs and other providers that supersede state scope-of-practice laws.
The nation’s largest healthcare delivery system recently initiated this process, hoping to help expand access to care amid the COVID-19 pandemic. But the American College of Radiology, American Society of Neuroradiology and others are “dismayed” that the Department of Veterans Affairs has operated opaquely in running the process.
In a Thursday letter to the VA’s leader, more than 100 physician groups including the ACR asked the massive health system to tread carefully in potentially expanding nonphysicians’ scope of practice.
“We are writing to express our serious concerns with the VA’s efforts to develop national standards of practice for physicians and other health professionals that supersede state scope of practice and licensure laws,” radiologists and other physicians wrote to Secretary Denis McDonough July 29. “The policies the VA is seeking to overhaul will have implications for standards of care beyond the VA,” the groups added later.
The previous presidential administration first released this interim rule in November, drawing ire from ACR a few months later. It proposes to allow Veterans Affairs clinicians to operate across state lines, regardless of local requirements, and asserts the 171-hospital system’s authority to establish national practice standards across VA facilities. The rule was merely meant to “confirm already-existing VA authorities,” the college said at the time. However, radiologists are concerned about a potential slippery slope leading the health system away from physician-guided care teams.
Veterans Affairs just recently started the process of developing the new standards of practice, as hinted in the original rule, according to those involved. The proposal would result in a national standard of practice for 48 categories of different health professionals. Radiologists and other physicians are also concerned that each category will be independent of one another, rather than emphasizing each professionals’ role in team-based care, according to the letter.
To read more, go to Radiology Business.