About health insurance
CMS Releases Final Rule for CY 2022 Medicare Physician Fee Schedule: “CMS has finalized the calendar year (CY) 2022 Medicare Physician Fee Schedule to promote greater telehealth utilization, boost reimbursement rates for vaccine administration, and improve health equity, among other initiatives, the federal agency said.
The final rule will implement ‘a series of standard technical proposals’ as part of CY 2022 rate-setting, CMS said. The conversion factor for next year will be $33.59, a decrease of $1.30 versus the CY 2021 conversion factor. Next year’s rate accounts for statutory changes to relative value units (RVUs) and the expiration of the 3.75 percent temporary CY 2021 payment increase Congress approved through pandemic-related legislation.
The CY 2022 conversion factor also reflects a statutory update of 0 percent and an adjustment necessary to account for changes in RVUs and expenses that would result from our finalized policies, according to the final rule.”
Hospital Price Transparency Penalties to Increase Under OPPS Rule: “Starting January 1, CMS will increase penalties for noncompliance with hospital price transparency requirements under the newly released Calendar Year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule.
The Final Rule sets the minimum civil monetary penalty of $300 per day for smaller hospitals with a bed count of 30 or fewer, and a penalty of $10 per bed per day for hospitals with a bed count greater than 30. However, the penalty is not to exceed a maximum daily dollar amount of $5,500.
Under the new approach, hospitals could be responsible for paying a maximum of over $2 million if they fail to comply with the requirements.”
Feds Nail Podiatrist For Alleged $11M Foot Bath Fraud Scheme : “A Mississippi podiatrist made Medicare and insurance companies foot the bill for more than $11. 3 million in prescriptions for pricey and unnecessary bath treatments, a federal indictment unsealed Tuesday claims. Foot doctor Carey ‘Craig’ Williams, 63, also allegedly took kickbacks for harvesting patients' toenails and wound swabs so a medical lab could perform, and seek reimbursement for, unnecessary bacterial and fungal screenings, prosecutors say. According to the indictment, Williams participated in the scheme for five years alongside two unidentified podiatrists and a Mississippi pharmaceutical sales representative…”
Can you spot the three puns in the story?
Bartko, Zankel, Bunzel & Miller Files Antitrust Lawsuit Against MultiPlan Co. & Major Health Insurers: “Bartko, Zankel, Bunzel & Miller filed a lawsuit on behalf of Verity Health Systems Liquidating Trust (‘Verity’) against MultiPlan and major health insurers for antitrust practices that violate California's Cartwright Act and Unfair Competition Law. MultiPlan admits its customers, healthcare insurance companies, paid Verity and other U.S. health care providers billions of dollars less annually than they otherwise would have for at least 10 years.
According to court documents, MultiPlan acted as an unlawful corporate hub as part of a "hub, spoke, and rim" agreement, together with most major insurance companies, to fix and artificially reduce the amounts of out-of-network reimbursement paid to hospitals. By setting lower, fixed prices for payments for healthcare provided by hospitals, MultiPlan worked with major insurance companies to exert their market dominance and cut reimbursements to hospitals by about $10 billion per year from 2012 through 2020.”
About Covid-19
Analysis of the Effectiveness of the Ad26.COV2.S Adenoviral Vector Vaccine for Preventing COVID-19: “This comparative effectiveness research study found that, through large-scale longitudinal retrospective curation of electronic health records from the multistate Mayo Clinic Health System, the Ad26.COV2.S vaccine [J&J] had an effectiveness of 74%.”
About pharma
Schumer announces deal to lower prescription drug prices: “The deal would allow negotiation after nine years for many drugs, known as small molecule drugs, and after 12 years for more complex drugs known as biologics, according to a summary obtained by The Hill.
If drug companies refuse to negotiate, they would face an excise tax as a punishment, a provision that has been controversial with some moderates.
Medicare could negotiate up to 10 drugs starting in 2025, and up to 20 drugs in 2028 and beyond, according to the summary.
Insulin copays would be capped at $35 per month.”
CVS Health beats on earnings, gets lift from Covid vaccines and prescription volumes: “The drugstore chain raised its forecast for the year, saying it expects adjusted earnings per share of $7.90 to $8.00, from $7.70 to $7.80.
The company administered 8.5 million Covid tests and 11.6 million shots during the three-month period.”
Company Q3 reports:
Novo Nordisk's sales, profit top expectations in Q3
Amgen boosts profit outlook despite Q3 sales hit by pricing pressure
Bausch Health's Q3 sales slip as earnings more than double
About the public’s health
'Impossible to enforce': Big Tobacco exploiting loopholes in European menthol ban: “Tobacco companies are finding loopholes in the Europe-wide menthol cigarette ban in order to keep selling products that can get new, younger smokers hooked on tobacco.
Japan Tobacco International (JTI) – which owns Sterling, Benson & Hedges and Sovereign – has been able to work around a ban imposed in 2020 that was intended to prevent young people from taking up smoking cigarettes. Competitors have called for governments to investigate the company’s new ‘menthol reimagined’ products.”
About healthcare professionals
Trends in Outpatient Care for Medicare Beneficiaries and Implications for Primary Care, 2000 to 2019: “Outpatient care for Medicare beneficiaries has shifted toward more specialist care received from more physicians without increased primary care contact. This represents a substantial expansion of the coordination burden faced by PCPs.”