Hospital Compliance Spotty On New Rule About Cost Disclosures
The rule is meant to give consumers information about prices for medical goods and services. The fine of $300 a day isn't a strong enough incentive for hospitals, an investigation reports.
The Washington Post:
Hospitals Drag Feet On New Regulations To Disclose Costs Of Medical Services
Hospitals are now required to disclose the prices they secretly negotiate with insurers. But many are dragging their feet on the new regulations, which were passed under President Donald Trump and could very well stay in place under President Biden. (Ellerbeck and Cunningham, 1/25)
Billing, Antitrust Exemption Changes Upend Negotiations Between Insurers And Providers
A flurry of recent mandates will completely upend the negotiating table between payers and providers, but how the final contracts will change going forward all depend on enforcement. Although most negotiations between hospital systems and insurers have been finalized for 2021, Rick Kes, a senior analyst at RSM, said recent mandates around surprise billing, price transparency and the antitrust exemption for health insurers will reverberate throughout the healthcare industry for years to come. In late January, CMS also approved a prior-authorization rule that requires payers to build application programming interfaces between their records and providers', in a move to speed decisions about whether patient procedures are covered. The changes will phase in during 2023 and 2024. (Tepper, 1/25)
Hospitals See Opportunity, Risk In Ambulatory Surgery Centers
Allegheny Health Network’s ambulatory surgery centers had a record year in 2020. Surgeries were up around 10% at the Pittsburgh-based integrated health system’s 10 ASCs, and Allegheny plans to move even more procedures into those facilities. Surgery centers generally have high physician and patient satisfaction given their convenience and efficiency and ASCs help ensure that more acute patients can be treated in hospitals, said Dr. Sricharan Chalikonda, Allegheny’s chief medical operations officer. Health systems continue to invest in ambulatory surgery centers. While reimbursement rates are typically significantly lower than the inpatient setting, ASCs provide lower-cost alternatives and free up inpatient capacity. (Kacik, 1/25)
The Baltimore Sun:
Gov. Larry Hogan Insults Anne Arundel Health Officer On Facebook Over School Reopenings; County Executive Steuart Pittman Says Let’s Talk
Gov. Larry Hogan told a constituent on social media Thursday that Anne Arundel Health Officer Nilesh Kalyanaraman “doesn’t really know what he is talking about” as he provides guidance on reopening county schools. Readers reached out to The Capital to point out the response, in which Hogan responded to a comment on his Facebook page dismissing the knowledge of a physician whose appointment he approved less than two years ago. (Pacella, 1/25)
How Likely Are Malpractice Lawsuits From Treating COVID?
Last May, Emily Reardon, a 19-year-old college freshman and former high school varsity swimmer, was brought by her parents to the Riverside Methodist Hospital emergency department (ED) in Columbus, Ohio, with severe respiratory distress and low pulse-oximetry readings. She was treated by an emergency physician. It looked like a case of COVID-19. But after testing negative three times for the virus, Reardon was sent home with her parents with a diagnosis of pneumonia and prescriptions for an antibiotic and acetaminophen. She returned 2 days later in respiratory distress with a dangerously low pulse-oximetry reading of 70%. She died 8 hours later. (Meyer, 1/25)
California’s Top Hospital Lobbyist Cements Influence In Covid Crisis
As intensive care units filled and coronavirus cases surged over the holidays, Carmela Coyle invoked a World War II-era quote attributed to British Prime Minister Winston Churchill to rally her own troops: “If you’re going through hell, keep going.” Coyle is head of the California Hospital Association, and her “troops” are the highly paid hospital executives she represents. Throughout the pandemic, as in the December memo in which she quoted Churchill, she has employed battlefield rhetoric to galvanize their massive political and financial clout. (Young, 1/26)