|HHS Extends Public Health Emergency for 12th Time|
By Susan Morse | January 11, 2023
Three years after the federal government announced the first public health emergency due to COVID-19, Health and Human Services Secretary Xavier Becerra has again extended the PHE. Becerra announced the extension Wednesday morning.
This is the 12th time HHS has extended the public health emergency. The declaration was first made in January 2020.
On October 13, 2022 Becerra issued another 90-day declaration.
Former HHS Secretary Alex Azar issued the first declaration on January 31, 2020, as the COVID-19 pandemic was just beginning to ramp up in the United States. Azar renewed the PHE on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021.
Becerra continued those renewals on April 15, 2021, July 19, 2021 and October 15, 2021, and on January 14, April 12, July 15 and October 13, 2022.
HHS has promised to give providers 60 days’ notice before ending the public health emergency.
To read more, go to Healthcare Finance News.
Fitch: 2023 Could be Turning Point for Nonprofit Health Systems
By Caroline Hudson | January 11, 2023
Nonprofit healthcare systems are in for a tough year, but a Fitch Ratings report released Wednesday projects even the hardest-hit providers may start to see improvement in the coming months.
The industry ended 2022 with depressed margins, and some health systems saw billions of dollars in operational losses. High labor costs, along with ongoing supply chain issues and inflation, continue to drag on systems’ financial performance. The challenges have no short-term fix, and labor expenses are expected to stay elevated through at least 2023, said Kevin Holloran, senior director at Fitch.
The credit ratings agency downgraded the nonprofit health system sector to “deteriorating” in August and maintains that outlook in its latest report, acknowledging the likelihood that negative outlooks for health systems will outnumber positive ones for a time.
Holloran said hospitals still need a better balance between medical and surgical volumes. The so-called “tripledemic” – COVID-19, respiratory syncytial virus and flu – means fewer inpatient beds are being used for revenue-driving services like elective surgeries.
“It’s almost a running joke that ‘I lose money for every case I do’ because the labor is so expensive, particularly in those medical cases,” Holloran said.
But 2023 could be a turning point, according to the report, which projects many providers will be able to break even in their operations on a month-to-month basis sometime this year, with “gradual improvement” from there.
“We think that we are beginning to come out of the worst of it and towards the end of the year, sometime during this year, we’re going to break through that barrier and get more and closer to back to normal,” Holloran said.
That doesn’t mean providers will leave their financial challenges behind. More systems are at risk of defaulting on credit agreements this year – a situation exacerbated by declining cash flow and growing interest expense. In December, Moody’s Investors Service reported 34 healthcare organizations were rated B3- or lower, holding nearly $65 million of combined outstanding debt.
Improvements in the investment markets or debt waivers would soften some of the hit to credit ratings, the Fitch report noted.
Holloran said he expects more systems to exit payer networks and contracts, as well as push for shorter contract periods, as providers continue to navigate expenses.
To read more, go to Modern Healthcare.
Lawmaker Pushes to Eliminate OOP Costs for Supplemental Breast Imaging
By Hannah Murphy | January 11, 2023
A member of the Missouri House of Representatives recently introduced legislation that would increase access to supplemental breast imaging by eliminating out-of-pocket expenses for the exams.
On Jan. 4, Representative Brenda Shields introduced a proposal (HB 575) that would remove financial barriers for women who are recommended to undergo supplemental breast imaging, such as an MRI, CT or ultrasound, when the exams are deemed medically necessary.
Shields, who worked alongside the Susan G. Komen organization to develop the bill, maintains that, if enacted, the legislation would save lives.
“When the threat of breast cancer rears its head, women and their doctors need every tool available to for an accurate diagnosis,” Rep. Shields said in prepared remarks. “This bill will save lives by ensuring treatment can begin as early as possible.”
Molly Guthrie, Vice President of Policy and Advocacy at Susan G. Komen, applauded Shields for her advocacy on behalf of Komen, stating that the legislation would have an immediate impact for thousands of women who need supplemental imaging but cannot afford it.
“Everyone should be able to access the care they need and afford it, especially when it could mean the difference between a person’s life and death,” Guthrie stated.
While the U.S. government mandates coverage of routine mammographic breast cancer screening based on recommended guidelines pertaining to age, risk, etc., coverage of supplemental imaging often falls in the laps of patients.
According to a study commissioned by Komen, supplemental breast imaging can exceed thousands of dollars in OOP costs, preventing many women from following through with radiologists’ recommendations.
And another recent study echoing that same sentiment found that more than 20% of women would forego supplemental imaging due to high deductibles and OOP expenses, especially in more vulnerable populations.
To read more, go to Health Imaging.
CVS Health Invests $100M into Hybrid Healthcare Company
By Amy Baxter | January 10, 2023
CVS Health Ventures, the corporate venture capital arm for the retail pharmacy giant, has invested $100 million into Carbon Health, a “hybrid” primary care services provider.
The investment is part of an initial close of Carbon’s Series D funding round and will enable Carbon to scale its connective care model to new areas, sign new value-based care arrangements and invest in technology. As part of the deal, CVS Health will also pilot Carbon’s operating model inside existing CVS Health locations, leveraging its software to do so for CVS customers.
Carbon Health’s connective care blends software and expert care so patients can establish a relationship with their own integrated team, monitor and manage their health and access in-person care when and where they need it.
“While healthcare has evolved tremendously over the past few years, there are still many ways in which care delivery and quality have not. We’re focusing on everyday touchpoints with an integrated care team to help patients achieve better health outcomes––because healthcare is not just what happens during a visit but also what happens in between,” Eren Bali, CEO and co-founder of Carbon Health, said in a statement. “Now, with the support of CVS Health, we can further accelerate our goal of designing healthcare as it should be––simple, flexible and personal.”
Carbon Health has more than 125 physical locations in 13 states, virtual care coverage and an average Net Provider Score (NPS) of 85, according to the company.
The news comes just after reports have swirled that CVS is in talks to acquire Oak Street Health, a primary care provider for Medicare, for a whopping $10 billion. CVS Health also moved to acquire home healthcare company Signify Health for $8 billion. The deals reveal CVS Health’s strategy to move further into the healthcare services space.
To read more, go to Health Exec.
The Healthcare Facilities Where No Surprises Act Disputes Are Most Common
By Jakob Emerson | January 10, 2023
Hospital emergency rooms make up 81 percent of where No Surprises Act disputes occurred between April 15 and Sept. 30, according to CMS’ initial report on the independent dispute resolution process.
Top places of service for disputes:
Hospital emergency room: 70,071Inpatient hospital: 11,432On campus outpatient hospital: 7,789ASC: 1,990Off campus outpatient hospital: 1,056Office: 328To read more, go to Becker’s Payer Issues.
Autonomous Radiology Stalwart Taking Health Insurance Internal
By Dave Pearson | January 10, 2023
The independent-practice coalition Strategic Radiology has founded a captive health insurance program, aka a “self-insured” or “self-funded” plan, which it will offer to its 1,500 or so member physicians and their respective support staffs.
Calling the operation SR Health, the 33-group alliance says the endeavor should help participants save 30% or so on premium payments while also giving them more control over coverage details and opening better visibility into plan data.
Already eight SR practices representing 2,000 enrollees are up and running with SR Health, Strategic Radiology says in an announcement posted Jan. 11.
SR adds that it expects “many more” of the 33 groups in its fold to sign on as their current contracts expire in the coming months.
The coalition has contracted with established companies to tap outside expertise in five areas, SR notes. The contract companies include a captive analyst and program manager, a reinsurance provider, a pharmacy benefits manager, a third-party administrator and a national broker.
Strategic Radiology CEO Scott Bundy, MD, suggests SR is in good company among U.S. employers looking for entrepreneurial ways to counter the endlessly rising cost of employee healthcare.
“Our practices came together, educated themselves on the options, and built an insurance captive program that will lower costs and improve flexibility for our member groups,” Bundy says. “In exercising an ownership mentality, Strategic Radiology member groups will reap significant cost savings and plan control.”
SR chief operating officer Barbara Perez Deppman adds that the new program is “a testament to the collaborative effectiveness of our owner-members.”
Full announcement here.
To read more, go to Radiology Business.
Affordability, Labor Shortages Top Issues for Healthcare Execs
By Jacqueline LaPointe | January 9, 2023
Confronting affordability and solving clinical labor shortages are among the top pivotal issues for healthcare executives in 2023, according to a new report from PricewaterhouseCoopers (PwC).
“The business environment of 2023 will likely force all health plans and health systems to confront affordability head on,” the report states. “They need to reshape strategies, reengineer financial and business models to aggressively deliver greater value — or others will.”
As the COVID-19 pandemic showed, remote and retail care are viable, even successful, alternatives to the traditional care model. Both types of care are a more convenient way to access medical care while typically costing patients less than visiting their doctor in the office or hospital.
But health systems and payers will have to transform their businesses while balancing a delicate clinical workforce. Health systems, in particular, are facing severe clinical labor shortages that are threatening margins and even hospital viability, PwC says.
Other pivotal issues for healthcare executives in 2023 include the digitization of healthcare, customer retention and acquisition, cybersecurity risk, and delivering value.
Delivering value to the consumer is key to confronting disrupting forces while ensuring the costs of care remain affordable for patients, the report indicates. Health systems will also “need to seize every transformational opportunity — from foundational technology investments, regulatory shifts, deals or crises — to clear the path for a drastically different cost, capabilities and business footprint by 2030.”
2030 is likely to be a pivotal year for health systems and payers, the report suggests. PwC believes that the healthcare sector will move to a new ecosystem in which organizations will need to adopt new roles to survive and thrive. They can either be orchestrators, which focus on delivering a seamless, humane experience; integrators, which align incentives and reduce waste for more convenience; or platform and solutions platers, which create technology and cloud infrastructure for better data management.
“Health services companies that follow their North Star — finding ways to develop stronger relationships with consumers and improve the patient experience, rethinking traditional workforce and business models, and continuing to invest in technology and innovation — will likely be well positioned for what’s next,” the report states.
To read more, go Revcycle Intelligence.