On the Radar – Health care news you should know

NOVO Health prides itself of being small and nimble in a sea of slow behemoths. But that doesn’t mean we don’t have a wide reach. That certainly came to the fore as the first wave of COVID-19 peaked across the country, creating challenges for independent health care providers that saw many scheduled procedures postponed in the name of safety. When it came to explaining the challenges, there was Sandi Rochon, NOVO Health’s own chief clin- ical integration officer featured in series of interviews by national health care IT consultants Alidade Group. All of our providers feel passionate about keeping their patient base, staff and communities safe. “The social distancing component helps to decrease the spread, so that was first and foremost,” Rochon said, explaining the new reality. “Our traditional doctors’ offices have really looked at anything they can do, such as telehealth, to keep patients out of clinics to reduce traffic and exposure.” She also highlighted the effort of team members who had volunteered for duty in other states or were sewing masks to help keep others safe.

Radical transformation

While the last months have been difficult for all health care facilities, the coming months and the migration of care to outpatient settings is the beginning of a movement that will forever change ambulatory surgery centers (ASCs), according to a recent ar- ticle in Becker’s ASC Review. Leaders at Surgical Directions, a specialty health care consulting firm, weighed in on how the coronavirus will affect the ASC landscape. “COVID-19 is going to speed the exodus of procedures from the hospital to the ASC,” said CEO Jeff Peters. “Eighty percent of all surgeries in this country are performed where the patient does not stay overnight, yet we’ve not fully utilized ASC capacity.” Senior Physician Medical Director Dr. Tom Blasco said, “With COVID-19 and recent trends, there’s been a radical transformation of who the customer is for these payers. It’s no longer just the surgeon, it’s the patients and the payers, and they’re directing their care to the ambulatory environment.”

It’s not over until it’s over

The Trump administration’s le- gal win requiring hospitals to publicly disclose the rates they negotiate with insurers may well be short-lived. In June, a federal judge granted a Health and Hu- man Services motion for summary judgement to move ahead with the rule. A rule issued in November requires hospitals to disclose all standard charges, including payer-specific negotiated rates, for all services be- ginning 2021. Industry groups sued. In a 43-page decision, a judge highlighted that HHS acknowledged and considered the arguments of provider organizations and payers when it issued the final rule and “did not act arbitrarily and capriciously in concluding that the final rule could have substantial benefits.” The AHA said it will appeal the decision and seek expedited review. “We are disappointed in today’s decision in favor of the administration’s flawed proposal to  mandate  disclosure of privately negotiated rates,” AHA General Counsel Melinda Hatton said in a release. “The proposal does nothing to help patients understand their out- of-pocket costs. It also imposes significant burdens on hospitals at a time when resources are stretched thin and need to be devoted to patient care. Hospitals and health systems have consistently supported efforts to provide patients with information about the costs of their medical care. “

The one certain outcome

COVID-19 has caused a lot of uncertainty for employers: Will my business bounce back? Are my employees safe? Will we make enough to stay in business? But there seems to be one certainty to the out- comes we can all expect, and much like death and taxes it will be just as welcome: higher health care costs. Medical costs could grow between 4 percent and 10 percent for employers in 2021, depending on how the COVID-19 pandemic plays out, according to a recent report issued by PwC. The findings are based on series of interviews conducted between February and May with industry leaders from companies representing more than 90 million employer-sponsored large group members. “Uncertainty remains about the impacts of COVID-19 and the economic downturn on health care spending in 2021,” the report said. “The health of the overall population could worsen slightly as individuals delay needed care, pushing up future health care costs. The number of individuals with employer-sponsored insurance is declining, driving down provider revenues that have already taken a hit from COVID-19.”

Just a bit outside

Medscape released its 2020 “Best & Worst Plac- es to Practice” list, examining compensation, practice conditions and quality of life across the U.S. Wisconsin did not make the list, finishing just outside at #14. Here are the top 10 states to practice in 2020 with the top suggested city and average physician compensation:

  1. Minnesota (Duluth): $236,270
  2. Washington (Bellingham): $238,350
  3. Massachusetts (Westborough): $186,040
  4. North Dakota (Fargo): $229,550
  5. Vermont (Montpelier): N/A
  6. New Hampshire (Hanover): $257,220
  7. Colorado (Highland Ranch): $220,710 8. Utah (Orem): $209,420
  8. Utah (Orem) $209,420
  9. Nebraska (Lincoln): $177,080
  10. Idaho (Idaho Falls): $234,290

Physician compensation data is based on Bureau of Labor Statistics data as of May 2019, the most recent data available.

A coughing fit

Timothy Regan thought he did everything right. An estimator for a construction firm in Colorado, he started experiencing symp- toms of COVID-19 and made his first call to a nurse hotline. From there, he was referred to urgent care which ultimately triaged to him to the emergency room. His ER visit was coded as a Level 4, the second highest on a 5-point scale. But he did not have COVID-19. The result: a $3,278 bill. His insurer paid $1,042, leaving Regan with $2,236 to pay based on his $3,500 in-network deductible. The biggest part of the bill was the $2,921 general ER fee. When patients use hospital emergency rooms — even for short visits with few tests — it’s not unusual for them to get billed thousands of dollars no matter how minor the treatment received. Many of the insurance companies are waiving cost-sharing for COVID-19, but Regan was not diagnosed. In fact, he was never tested. The Regans knew they had a high deductible and they try to avoid unnecessarily using the ER. But, with physician offices not seeing patients with COVID-type symptoms in April, Timothy said he had little choice when Denver Health directed him first to the urgent care, then to its ER. In the end, they got it right and the Regan’s claim was reprocessed following an inves- tigation by the Kaiser Health News and NPR.

Crypto comes to the rescue

It seems one of the keys to unlocking a truly digital health care experience has been hiding in plain sight. Blockchain, a core component in the security of crypto currencies may be the solution for privacy concerns that currently slow the digitization and exchange of health information, according to “OMICS: A Journal of Integrative Biology.” Privacy is a major concern when it comes to storing and sharing health data, and with current health care data storage systems lacking top end security, blockchain can provide a solution to vulnerabilities such as hacking and data theft. Blockchain technology in health care also offers interopera- bility, which enables exchange of medical data securely among the different systems and personnel involved, offering a variety of benefits such as effective communication system, time reduction and enhanced operational efficiency.

The surprise would be an actual solution

Surprise billing was supposed to be last year’s easy health policy fix. Industry lobbyists, consumer advocates and lawmakers all agreed insured patients shouldn’t receive high bills when they’re taken to the emergency room or inadvertently treated out of network. As re- ported in a recent issue of Politico. the issue has become the object of months of fierce lobbying and rivalries between congressional health committees, though the matter has receded during the pandemic. Congress agreed to cover the cost of COVID-19 testing in an earlier rescue package, and the Trump administration blocked providers that accept any part of a $175 billion industry bailout fund from sending unexpected bills to coronavirus patients. So-called balance billing can hit insured patients with staggering unanticipated medical bills if they inadvertently get treated at an out-of-network facility, such as in an emergency situation. Even people who go to an in-network facility may later discover one of the physicians wasn’t part of the network. Despite mounting public concern and a flurry of legislative activity, Congress over the past year couldn’t resolve a stand- off involving hospitals, physicians, employers and insurers that mired bipartisan proposals and pitted powerful health committees against each other. Efforts to help hospitals and physicians during the pandemic have left the outlook murky.

Sean Johnson

Sean Johnson

Editor/Publisher NOVO Live, Public Relations Manager, NOVO Health, (920) 851-1170, sean.johnson@novohealth.com

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