About health insurance/insurers
CMS puts No Surprises Act payment determinations on hold after court loss CMS is instructing certified independent dispute resolution entities to hold all payment determinations under the No Surprises Act until HHS and the Treasury Department issue further guidance.
The request comes after a federal judge in Texas ruled Feb. 6 that the No Surprises Act's revised arbitration process ‘continues to place a thumb on the scale"‘in favor of insurers and ‘that the challenged portions of the final rule are unlawful and must be set aside.’”
Pharmacist Convicted for $1M Prescription Drug Fraud “…Ronald A. Beasley II, 33, of Portsmouth, was the pharmacist in charge at NH Pharma, a pharmacy located in Lake Mary, Florida. Through NH Pharma, Beasley and his co-conspirators billed Medicare for expensive compound drug creams that they never actually purchased or dispensed, and instead provided Medicare patients an inexpensive compound drug cream not covered by Medicare. Inventory records showed that NH Pharma did not buy enough of the expensive prescription drugs to fill all the prescriptions NH Pharma billed to Medicare. In total, Beasley and his co-conspirators received more than $1 million in fraudulent proceeds from Medicare.”
Cigna rebrands to the Cigna Group “Cigna is rebranding to The Cigna Group and launching two brands under the new corporate umbrella.
The company said Feb. 13 that the new health benefits segment is called Cigna Healthcare and will serve its commercial, government and international members.
Evernorth Health Services will house the company's pharmacy, care delivery and benefits solutions. Express Scripts, Express Scripts Pharmacy, Accredo, eviCore, MDLIVE and myMatrixx will exist under the Evernorth name.”
Compare to United HealthCare and Optum.
Kaiser posts $4.5B net loss in 2022 amid staff shortages, economic headwinds “Oakland, Calif.-based Kaiser Permanente reported a net loss of $4.5 billion in 2022, down from a net income of $8.1 billion in 2021, according to its financial results released Feb. 10. Its operating margin dipped from 0.7 percent in 2021 to -1.3 percent in 2022.
The swing from net income in 2021 to net loss in 2022 reflects an increase in healthcare costs driven by inflation, high COVID-19 costs, ongoing labor shortages and a rise in care volume, according to Kaiser, an integrated healthcare provider with 39 hospitals.”
CMS physician pay down 22% from 2001-2022; providers urge Congress to fix 'broken' system “Adjusted for inflation in practice costs, Medicare physician payment declined 22 percent from 2001 to 2022, according to the American Medical Association. In addition, as commercial payers typically base their reimbursement rates on Medicare rates, their physician payments have also declined over this period, though it is unclear by how much since that information is not publicly available and varies from insurer to insurer.”
About hospitals and healthcare systems
The No. 1 problem keeping hospital CEOs up at night FYI (top 5):
”1. Workforce challenges (includes personnel shortages and staff burnout, among other issues) — 1.8
2. Financial challenges — 2.8
3. Behavioral health and addiction issues — 5.2
4. Patient safety and quality — 5.9
5. Governmental mandates — 5.9”
Henry Ford, MSU, Pistons dunk $2.5B into expanded health facilities in the Motor City “Henry Ford Health, Michigan State University and Detroit Pistons owner Tom Gores announced a plan to pump $2.5 billion into a new joint medical research center, hospital expansions, housing developments and public spaces. The community development project aims to turn the city's New Center neighborhood into a ‘vibrant, walkable community with state-of-the-art residential, commercial, retail, recreational and health care components,’ officials said in a press release.”
About healthcare IT
Doximity rolls out beta version of ChatGPT tool for docs aiming to streamline administrative paperwork “The open beta site, called DocsGPT.com, is an integration with ChatGPT that works with Doximity’s free fax service, said Jeffrey Tangney, Doximity co-founder and CEO, during the company's fiscal 2023 third-quarter earnings call Thursday.”