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Recent concerns about the future of the federal insurance marketplace prompted a meeting between Obama and some of the heads of the remaining ACA exchange insurers.  Aetna and UnitedHealthcare recently exited the ACA insurance exchanges causing additional alarm in the industry.  In a letter from Obama to all ACA Marketplace insurance companies, Obama refers to the ACA as a “historic change” to the US health system, “that has improved health quality, equity, affordability, and outcomes.”  Read the full article.   Published by:  Modern Healthcare:  Virgil Dickson  September 12, 2015

Some consulting companies are offering a “helping hand” to health insurance companies to glean specific information from their patient data.  This approach is a way for insurers to “manage” patients, instead of avoiding them as they have in the past.  This method of using “big data” to identify high-risk patients may not be so advantageous for the patients.  The insurance companies assert that the use of this method is an effort to “pinpoint the high-risk patient and manage their care so they don’t wind up in the emergency room or in a hospital bed”, or to “keep them healthy”.  Is this a bit overreaching or could this…
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On October 1, 2015, CMS implemented the ICD-10 code set which allowed/forced health care providers to use a higher level of specificity when diagnosing their patients.  This new rule made it mandatory for physicians to discontinue use of ICD-9 codes and begin using ICD-10.  In an effort to allow physicians time to get to know the new code set, CMS allowed a 1-year grace period for providers to use “unspecified” ICD-10 codes on Medicare FFS claims.  This grace period, referred to by CMS as “ICD-10 flexibilities”, is coming to an end on October 1, 2016, less than a month from now.  This could cause a…
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Aetna announced on August 2nd that it plans to halt its Obamacare expansion in 2017.  Like other major players in the insurance market, Aetna continues to lose money on the exchange plans.  They will also determine whether or not they will continue to offer these contracts at all moving forward. United Healthcare, Humana and Anthem Inc. also have concerns about the high losses they are incurring from their Obamacare plans. Mark Bertolini, Aetna’s CEO,  who previously “believed the insurer had an obligation to stick with the public health exchange” has changed his opinion on the matter.  He currently believes everyone is…
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The Obama administration continues to defend the funding of the Affordable Care Act following the GOP report that found the funding violated the Constitution.  The report insists that the Obama administration used money not approved by Congress for the ACA cost-sharing program. In this Modern Healthcare article referenced below, Shannon Muchmore elaborates on the GOP lawsuit and what has ensued in the aftermath.  Concerns about witness preparation and cooperation with the investigation may be construed as “cloaking illegal activity behind good intentions”. Read On   Published by:  Modern Healthcare: July 7, 2016 {Also see our previous blog “ACA Lawsuit won by House…
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In a recent Medscape article by Howard Waitzkin, MD, PhD, he discusses the potential need for doctors to disobey to maintain independence and quality of care for patients. The Editor notes that the recent UK “junior doctors’ strike” is a great example of physician disobedience with a goal of “physician unity to protect autonomy”.   Dr. Waitzkin goes on to discuss his history in medicine and how the increased administrative demands have increased drastically over the years ultimately hindering his ability to effectively care for his patients.  His article justifies why he eventually made the decision to “disobey” and how he…
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CMS agency officials say that the new MACRA program will offer healthcare providers greater simplicity and flexibility but the proposed MACRA requirements have physicians and healthcare organizations concerned about a breach in patient privacy.  The concern is that providing “quality information” via an EHR or registry on all patients, regardless of payer, oversteps patient privacy laws.  Many Providers and Healthcare organizations voiced their (primarily critical) opinions by submitting nearly 4,000 comments to CMS prior to the June 27th deadline. Read Modern Healthcare Article Published by:  Modern Healthcare:  Virgil Dickson June 28, 2016

More expensive, high-deductible insurance plans are growing and resulting in higher patient debt and the inability of patients to pay their medical bills.  Hospitals and physicians are taking a more aggressive approach to collecting from patients.  Hospitals have started a proactive approach by screening patients (prior to procedures) to determine their willingness and ability to pay.  Some Hospitals are also helping patients determine if they qualify for charity care or publicly subsidized coverage.   Engaging collection agencies and filing collection lawsuits against patients is becoming more and more prevalent as well. See Modern Healthcare Article Published by:  Modern Healthcare:  Harris Meyer  June 28, 2016

The Obama administration unconstitutionally spent money that Congress never appropriated to pay for part of the Affordable Care Act.  The ACA “Cost sharing” provision requires insurance companies offering ACA Health Plans to reduce out-of-pocket costs for policy holders that qualify.  The Government reimburses the insurance companies by reimbursing them for these offsets.  In May of this year, U.S. District Judge Rosemary Collyer sided with House Republicans.  In her ruling she wrote:  “Congress is the only source for such an appropriation, and no public money can be spent without one”. House attorney Jonathan Turley believes the ruling shows that Obama’s “signature” health care law “violated…
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In a June 8th article by Bob Herman, Modern Healthcare, he discusses how Aetna is downplaying the timing of its $13 billion debt offering for the Humana acquisition (Aetna Downplays Humana Acquisition).  Many are concerned about the Aetna / Humana merge and the potential Anthem / Cigna merge as this would narrow competition to the “big three” – Aetna, Anthem and UnitedHealth Group. Aetna Downplays Humana Acquisition Lynch repeated that mindset and said Aetna has been “very respectful with the Department of Justice in recognizing they have a job to do.” The U.S. Justice Department’s antitrust division has the final say on the merger….
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