About health insurance
AMA: Insurers misused CPT codes to hide administrative costs: According to an amicus filing, the AMA said Aetna used code 97039 to charge a patient an administrative fee when billing for a chiropractic visit. Optum was identified as the provider network under contract. The case is now before the 4th District Court of Appeals in Virginia because a lower court denied the Aetna’s liability for passing along the fee through CPT codes. The AMA argues that since Aetna is not a provider, it can not legitimately use a CPT code. (The AMA has a copyright for the CPT codes).
Healthcare billing fraud: 8 latest lawsuits, settlements: Most of these cases are identified as Medicare fraud.
Concentration of Healthcare Expenditures and Selected Characteristics of High Spenders, U.S. Civilian Noninstitutionalized Population, 2017: Highlights from the latest Medical Expenditure Panel Survey:
“In 2017, the top 1 percent of persons ranked by their health care expenditures accounted for about 22 percent of total health care expenditures, while the bottom 50 percent accounted for only about 3 percent.
Persons ages 65 and older and whites were disproportionately represented in the top spending tiers.
Inpatient hospital care accounted for 40 percent of spending for persons in the top 5 percent of the spending distribution.
About three quarters of aggregate expenses for persons in the top 5 percent of spenders were paid for by private insurance and Medicare.”
About the public’s health
President Trump made it harder to fight coronavirus by actions he took two years ago: This article details the federal administrative and financial issues that may impede effective handling of the COVID-19 epidemic. Yesterday President Trump appointed VP Pence to oversee the effort. But without an effective team, prospects for success are highly suspect.
Schumer requesting $8.5 billion in emergency funding on coronavirus: The Democrats are upping the ante from the goal of $2.5 billion set by Republicans. No one really knows how much is needed so the numbers are, for now, political gamesmanship.
Former Insys Executives Must Hand Over $57 Million for Kickback Scheme: “A federal judge in Massachusetts ruled that seven former Insys Therapeutics executives must pay nearly $57 million in restitution for their role in the company’s scheme to boost prescriptions of its sublingual fentanyl spray Subsys.” This article is a reminder that Purdue Pharma was not the only company involved in the opioid crisis. What distinguishes this firm from others (which falsely promoted product safety) is the bribes it paid prescribers.
Association of Nonprofit Hospitals’ Charitable Activities With Unreimbursed Medicaid Care After Medicaid Expansion: “In this study, large decreases in uncompensated care among tax-exempt hospitals associated with Medicaid expansion were not accompanied by increases in other reportable categories of community health benefit spending. Instead, they were accompanied by increased spending on unreimbursed Medicaid expenses.”
About healthcare IT
GoodRx Saves Money on Meds—It Also Shares Data With Google, Facebook, and Others: “While people… are saving money with GoodRx, the company’s digital products are sending personal details about them to more than 20 other internet-based companies. Google, Facebook, and a marketing company called Braze all receive the names of medications people are researching, along with other details that could let them pinpoint whose phone or laptop is being used.”
Amazon, Microsoft team up with Consumer Technology Association on healthcare AI standards: “Big names in technology, including Amazon, Microsoft, and IBM, worked with healthcare industry groups to develop a standard for the use of artificial intelligence in healthcare.
Convened by the Consumer Technology Association (CTA), a working group made up of 52 organizations set out to create a common language so industry stakeholders can better understand AI technologies.
The standard, which was released Tuesday, has been accredited by the American National Standards Institute (ANSI).”
About healthcare quality
Safety in Numbers: Hospital Performance on Leapfrog’s Surgical Volume Standard Based on Results of the 2019 Leapfrog Hospital Survey: The Leapfrog Group’s latest survey gives quality volume criteria for a number of procedures. While results are better than last year, no procedure achieves at least a 50% volume standard for surgeon and institution. Obviously rural hospitals perform particularly poorly. A case of access and quality tradeoff.
About pharma
Ownership—But Not Physical Movement—of Selected Drugs Can Be Traced Through the Supply Chain: The Office of Inspector General found that “the ownership of 37 of 44 selected drug products could be traced through the supply chain using drug product tracing information that the Drug
Supply Chain Security Act (DSCSA) requires…
Additionally, for 21 of 44 selected drug products, we found that—unlike with their ownership—we could not trace their physical movement through the supply chain using tracing information. We could not identify the shipping locations of trading partners (e.g., manufacturers, wholesale distributors, and dispensers) or third-party logistics providers that shipped or stored the drugs on behalf of the trading partners. Although the DSCSA does not require this information, should FDA not have access to this information in case of a drug safety emergency…”
The OIG’s most important recommendation is “that FDA seek legislative authority to require information about a drug product’s complete physical path through the supply chain on tracing information.”
As previously reported, blockchain is a great way to meet this need.
About healthcare competition
State Policies on Provider Market Power: “This report catalogues existing state statutes designed to address market power imbalances that enable anti-competitive practices and escalating health care costs… In addition, because states may pursue policies that exist outside their legislative codes, the report also notes some of the non-legislative efforts that states are taking to address these issues.”
This study is a great in-depth reporting of several categories of measures states are using to reduce costs, e.g, antitrust laws, transparency requirements, prohibition of “most favored nations” price contracting, and more. It is encouraging that there is so much activity at the state level as the federal government is stalemated on solving many problems (like surprise billing).