Blue Cross Antitrust Legal Woes Linger as Settlement Opt-outs Seek Damages
By Nona Tepper | September 29, 2021
More than 30 people who opted out of Blue Cross Blue Shield’s $2.67 billion antitrust settlement sued the health plan’s national association on Monday, alleging the insurers’ monopolistic activities increased healthcare costs while decreasing quality of care.
The suit, filed in the U.S. District Court of the Southern District of Florida, comes on behalf of 32 people living in five states and the District of Columbia who were at some point insured under one of 18 Blues plans issued by their employers. These plaintiffs chose not to participate in the preliminary settlement approved by federal Judge David Proctor of the northeastern district of Alabama last year.
The prior agreement aims to resolve a major lawsuit first filed in 2012 by customers who accused the Blues companies of limiting competition and product development, and of violating the Sherman Antitrust Act, an 1890 federal law that outlaws monopolies and restraint of trade. By opting out, the plaintiffs who were individually insured are objecting to
the deal and seeking separate—and presumably larger—payouts. Blue Cross and Blue Shield companies provide health coverage to more than 100 million people, or one in three U.S. residents.
The insurers’ “anticompetitive agreements, implementing conduct and foreclosure of competition have prevented consumers from being offered competitive premium prices,” the lawsuit says. The companies also “prevented consumers from being offered health insurance policies that offered better services and coverage that would result from competition in the marketplace.”
The plaintiffs are asking the court for injunctive relief that would stop Blue Cross and Blue Shield affiliates from restricting competition between Blues carriers, limit how the companies can use their Blues branding and ending a practice requiring a specific portion of company revenues come from Blue Cross and Blue Shield policies. The customers also are seeking treble damages, reasonable attorneys’ fees and any other legal or equitable relief deemed just and proper, along with a jury trial.
As part of the preliminary antitrust settlement, the Blue Cross and Blue Shield Association rescinded a rule that limited the amount of revenue its 35 member plans could generate from non-Blues-related businesses.
To read more, go to Modern Healthcare.
Medicare Advantage Premiums to Decline Slightly in 2022, Part D to Rise by Nearly 5%
By Robert King | September 29, 2021
Average Medicare Advantage plan premiums are expected to hit $19 per month next year, a slight decline from the $21.22 in 2021.
But Medicare Part D plan premiums will continue to increase by nearly 5% to $33 next year compared to the current premium of $31.47, new federal data show.
The premium data, released Wednesday by the Centers for Medicare & Medicaid Services (CMS), also come with a projection that MA enrollment will reach 29.5 million next year, compared to 26.9 million in 2021. Open enrollment for MA and Part D plans starts on Oct. 15 and runs through Dec. 7.
“Open enrollment is the one time each year when more than 63 million people with Medicare can review their healthcare coverage to find new plans or change existing plans, discover extra benefits and help them save money,” CMS Administrator Chiquita Brooks-LaSure said in a statement Wednesday.
CMS said the average Part D premium’s nearly 5% hike is based on “plans’ expectations of per capita drug spending in the coming year.”
More MA plans are expected to offer supplemental benefits for the chronically ill this year, with 25% of plans offering such benefits compared to 19% last year.
CMS also saw an increase in the number of dual-eligible special needs plans, which aim to better coordinate care for people on both Medicare and Medicaid.
To read more, go to Fierce Healthcare.
Provider Offering Workplace and At-home Diagnostic Imaging Expands into 22nd State
By Marty Stempniak | September 28, 2021
A Rochester, New York-based firm specializing in at-home or workplace ultrasound and X-ray imaging is expanding into its 22nd state, leaders announced Tuesday.
Founded in 2016, EZaccessMD calls itself the “first and only” provider to offer both teleconsults with board-certified physicians and in-person diagnostics. The group recently inked a partnership with Accurate Imaging in Oshkosh, Wisconsin, allowing for expansion across the Badger State.
EZaccessMD partners with health plan carriers to help blunt healthcare costs, offering more than 80% of urgent care services and dispatching technologists and imaging equipment within two hours.
“Accessibility to quality health services continues to be a critical barrier for communities nationwide, amplified only further by COVID-19,” company President Lois Irwin said Sept. 28.
EZaccessMD offers its services as either an enhancement for existing health insurance plans or standalone perk at small companies where traditional care options are limited. Employers typically pay only for what employees and their families use, starting at $4 per individual each month. Consumers can access their phone or video consults 24/7, while mobile
diagnostics are offered between 6 a.m. to 11 p.m.
Earlier this year, EZaccessMD also announced its expansion into Indiana and Michigan.
To read more, go to Radiology Business.
Big Health Insurers Control Market in Nearly Three-fourths of the U.S., AMA Report Shows
September 28, 2021
Almost three-fourths of U.S. metropolitan areas lacked a competitive health insurance market in 2020, with shrinking options among payers harming patients and providers, the American Medical Association concluded in a study published Tuesday.
Seventy-three percent of 384 metropolitan statistical markets were highly concentrated in 2020, up from 71% in 2014, the physicians’ society reported in its 20th annual study of health insurance markets. In many cases, competition declined in areas dominated by just a few health insurers. Fifty-four percent of markets that were designated as highly concentrated in 2014 became even less competitive by 2020, and another 26% markets also reached highly concentrated levels, the report says.
Consolidation among insurers leads to lower payments for doctors and higher premiums for policyholders, research has shown. The health insurance lobbying group AHIP did not respond to an interview request about the AMA’s findings.
President Joe Biden has pledged that federal regulators will take a more critical stance toward corporate mergers, including between healthcare companies, than did prior administrations.
“As merger rumors involving health insurers swirl, the prospect of future consolidation in the health insurance industry should be more closely scrutinized given the low levels of competition in most health insurance markets,” AMA President Dr. Gerald Harmon said in a statement.
To read more, go to Modern Healthcare.
‘A Troublesome Trend’: Top Imaging Groups Slam Insurer-directed Test Substitution Policies
By Matt O’Connor | September 27, 2021
Imaging tests must be ordered based on shared decisions and not insurance mandates, leading cardiovascular imaging societies argued in a new position statement.
Over recent years, private insurers and radiology benefits managers have started forcing providers to use one diagnostic test over another. These test substitution policies have become a “troublesome trend” that can lead to delays in care, patients undergoing incorrect exams or unnecessary testing.
Top cardiovascular imaging groups, including the American Society of Nuclear Cardiology and American College of Cardiology Imaging Council, recently denounced such policies in a statement published in the September issue of JACC.
“Cardiovascular test selection is highly nuanced and needs to reflect numerous variables, including individual patient factors, local expertise and access, and technology-related details,” ASNC’s immediate past President and senior author Sharmila Dorbala, MD,MPH, said. “Insurers’ push to use a single first-line test in all patients with chest pain is not
supported by evidence and may undermine a patient’s confidence in, and adherence to, their treatment plan.”
Focusing specifically on imaging for chest pain, the authors want more research on the impact of these substitution directives. They mentioned five consensus principles:
“This statement points to the unmeasured harm that may be caused by overly assertive managed care and test substitution and calls for more research in this area,” ASNC President Randall C. Thompson, MD, explained while pointing out the significance of major cardio imaging groups coming together under one cause.
The document is also endorsed by leadership at the American Society of Echocardiography, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine and Molecular Imaging.
Read the entire statement here.
To read more, go to Health Imaging.
Contributions to ACR Registries Now Eligible for MIPS Credits
September 21, 2021
Medical imaging practices and radiologists who contribute images and data to either the American College of Radiology’s (ACR) COVID-19 Imaging Research Registry or Lung Cancer Screening Registry can now claim Medicare Merit-based Incentive Payment System (MIPS) credits.
The credits would enable most radiologists and practices to fully meet yearly MIPS “Improvement Activity” requirements by the U.S. Centers for Medicare and Medicaid Services, according to the ACR.
To read more, go to Aunt Minnie.