"California regulators fined two insurance giants for overstating their Obamacare doctor networks and said the companies will pay millions of dollars in refunds to patients who paid too much for care.
The state’s Department of Managed Health Care levied fines of $350,000 against Blue Shield of California and $250,000 for Anthem Blue Cross.
At issue were the companies’ error-riddled provider directories that frustrated many consumers statewide as they tried to find doctors during the rollout of the Affordable Care Act in 2014. As a result, some patients incurred big unforeseen medical bills because they unwittingly went out of network for care.
In addition to the state's enforcement action, consumer lawsuits are still pending against both insurers."
Read more at LA Times
"The CMS says doctors tending to tens of millions of chronically ill Medicare patients aren't taking advantage of federal dollars aimed at improving care and reducing hospital readmissions and overall costs.
This year, Medicare began paying an average of $42 per patient per month for non-face-to-face chronic-care management services, such as consulting with other doctors caring for the same patient who might be dealing with dementia, heart disease or arthritis.
The CMS estimates 70% of Medicare beneficiaries—roughly 35 million—would be eligible, but CMS has only received reimbursement requests for 100,000 beneficiaries thus far, Kathy Bryant, a senior technical adviser in the Center for Medicare, said last week at an Advisory Panel on Outreach and Education meeting. She added that even that number may be too high as some could be duplicate claims.
One possible reason for the low interest is that doctors have to get permission from patients who are responsible for a 20% copayment each time their provider bills for the services.
“Getting bills for things when they haven't seen a doctor is not something they are used to,” Bryant said.
Others said the CMS didn't provide enough information on how to properly bill under the codes.
“Physicians are leery about using them because they don't know if they are doing so correctly,” said Regina Mixon Bates, founder and CEO of the Physicians Practice S.O.S. Group, a healthcare consulting and education firm. Another reason could be the lengthy process on electronic health-record systems."
Read more at Modern Healthcare
"Gov. Jerry Brown has signed legislation that requires weekly updates to health-service provider directories so people know what doctors and hospitals are in their network when they they shop for coverage or seek care.
Senate Bill 137 by West Covina Democrat Ed Hernandez responds to consumer complaints about inaccurate online directories. This has been a problem for years, but things got worse when thousands of consumers tried to pick a plan and provider after signing up for new insurance under the Affordable Care Act.
The problem got so bad that Covered California took its provider search tool down in February 2014. It still isn’t up — consumers are directed to individual health plan websites instead. The Department of Managed Health Care slammed Anthem Blue Cross and Blue Shield of California last year for failing to provide accurate provider lists. The agency is preparing to do follow-up surveys to see if inaccuracies have been fixed, spokesman Rodger Butler said."
Read more at Modern Healthcare
"For the last four years, Medicare has wielded a big stick: It has fined hospitals if too many of their patients returned to any hospital within weeks of being released.
But many safety-net hospitals, including academic teaching hospitals, say this is unfair because they take care of sicker, poorer patients.
Now data released Monday shows they may be right.
Researchers at Harvard Medical School found that hospitals are being penalized to a large extent based on the patients they serve. The researchers found that nearly two dozen variables, such as patients’ education, income and ability to bathe, dress and feed themselves, explain nearly half of the difference in readmission rates between the best- and worst-performing hospitals."
Read more at The Washington Post
"Medical giant Cedars-Sinai Health System said Tuesday it has acquired nearby Marina Del Rey Hospital, adding to a flurry of similar healthcare deals. Cedars-Sinai said it has purchased the 145-bed hospital and its neighboring medical office building. The price wasn't disclosed.
Marina Del Rey Hospital will operate as an affiliate of Cedars-Sinai and continue to provide its existing services, including a 24-hour emergency room. All 660 hospital employees will remain in place, according to Cedars-Sinai.
Marina Del Rey Hospital was owned by a partnership led by Westridge Capital, a private investment firm based in Los Angeles.
The deal fits in with Cedars-Sinai's ongoing efforts to expand and make care more convenient to patients in the community. It's also part of a larger consolidation trend among U.S. hospitals and, more recently, big health insurers."
Read more at LA Times
"California public health officials have released a report highlighting how demographic disparities across the state affect physical and mental health, Payers & Providers reports.
Details of Report The 96-page report was released by the California Department of Public Health's Office of Health Equity.
Overall, OHE Deputy Director Jahmal Miller said the report demonstrates how health outcomes are affected by:
Read more at California Healthline
"A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers’ experiences under the ACA’s coverage expansions and their opinions about the law"
Read more at The Commonwealth Fund
"Darren Gold had a stomach virus the first time he used an app called Heal to summon a doctor to his Beverly Hills home. He liked the Stanford-trained doctor who showed up so much that he called Heal again when his 2-year-old son had a fever, and again when the whole family had colds.
The charges—$99 each for the first two visits; $200 for the family—weren’t covered by insurance, but Mr. Gold, who owns a corrugated-box company, says that was still a bargain compared with taking time off work to go to the doctor. “Now, whenever my son bumps himself, he says, ‘Daddy, we need to get the doctor here,’ ” Mr. Gold says."
Read more at The Wall Street Journal
"Super-utilizers are the frequent fliers of the health care system, whose serious illnesses send them to the hospital multiple times every year and cost the system hundreds of thousands of dollars annually. Figuring out how best to address these patients’ needs and reduce their financial impact on the health care system is a subject of intense interest among policymakers. Now a new study has found that, in contrast to the notion that “once a super-utilizer, always a super-utilizer,” many patients who use health care services intensely do so for a relatively brief period of time.
Research and news reports often point out that super-utilizers are often uninsured or on Medicare and Medicaid and account for a large percentage of health care spending. Federal officials have suggested that their “large numbers of emergency department [ED] visits and hospital admissions … might have been prevented by relatively inexpensive early interventions and primary care.” Many of the programs that have been developed to reduce super-utilizer health care use have focused on the needs of people with multiple chronic conditions, ensuring they have a medical home through which their care is coordinated, for example, or addressing their social services needs."
Read more on Kaiser Health News
"The CMS lowered its final increase for hospitals rates in 2016 to a scant 0.9%, down from the 1.1% increase it proposed in April. The move will heighten pressure on the nation's 3,400 acute-care hospitals to rein in costs and reduce unnecessary spending.
The 435 long-term care hospitals certified by Medicare will see a 4.5% cut in their payments in fiscal 2016, which begins Oct. 1. The CMS on Friday posted a final rule that said long-term care hospitals can expect to see a decrease in payments by $250 million next year.
The inpatient prospective payment system is meant to create incentives that encourage efficiency and reduce unnecessary costs in U.S. hospitals that offer care to Medicare beneficiaries. The changes outlined will further those goals, the CMS says, while maintaining the financial viability of the hospital industry and ensuring access to high quality healthcare for Medicare beneficiaries."
Read more at Modern Healthcare
© 2022 Elizabeth Shubov