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Fixing our broken system
Plus: More scrutiny for Medicare Advantage and changes in Atlantic Canada
Good morning and happy Friday. It is 24 February 2023 and this is your weekly digest of healthcare news that matters to your practice or patients.
In the news:
Medicare Advantage plans to face more scrutiny
New rule changes by the Centers for Medicare and Medicaid Services will provide more oversight and scrutinize upcoding by Medicare Advantage plans. The rule changes will also require them to return overpayments found on audits dating back to 2018. As you might expect, with Medicare and other entitlements in the bullseye of the budget debate raging in Washington, CMS cannot afford to provide excessive payments for Medicare Advantage plans. Read more from North Carolina Health News.
California says they can no longer pay for COVID-19 vaccines and testing at migrant health centers
As the State of California face at $22.5 billion deficit, Governor Gavin Newsom says state can no longer contribute to migrant health facilities set up on the US-Mexico border that provide COVID-19 vaccines and testing. These facilities receive their funding from the federal government and other grants, but the state began to provide support during the deadliest stages of the pandemic. Governor Newsom has called on the Biden Administration and Congress to provide more aid to the state to fund these centers; the White House has not commented on the matter and no bills have been introduced in Congress. Read more in the San Diego Union Tribune.
Atlantic Canada reforms physician license rules
Canada’s healthcare system is always interesting, perhaps because it is different than ours and this week a rule change will allow physicians to work across provincial lines in Atlantic Canada. For most of Canada, physicians who are licensed in one province cannot practice medicine in other provinces. Now in New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador, physicians can practice medicine and work in the other provinces. Supporters of the change say it will help alleviate the doctor shortage in Atlantic Canada. Critics say it could lead to brain drain and see doctors flock to larger cities like Halifax or Charlottetown where they could make more money. Read more from CBC.
Other articles of interest:
Reforming America’s healthcare system
As I said above, Medicare and other entitlements are in the limelight amidst the ongoing debate in Congress about the debt ceiling and the federal budget. While Medicare is only a piece of the federal budget (and federal deficit), our healthcare system is a significant portion of our economy and it is only growing. As Senator Bernie Sander’s continues to reiterate, we have the most expensive healthcare system in the world.
As Ron and I have discussed several times on the FLATLINING Podcast, we would argue that we also have the highest quality healthcare anywhere in the world and the best access to healthcare. But, Senator Sanders is right: it is expensive.
That is in part because of our insurance system. Now, I’m not going to start to attack fee-for-service or anything like that; that is how most of our economy runs. Economists and legislators (and physicians) agree something doesn’t work. Something must be reformed.
The Affordable Care Act attempted to solve the problem of the uninsured and underinsured. It has, to an extent. In many markets across the US, however, there is only one option available on the exchange leaving patients little choice.
The No Surprises Act attempted to fix the problem of out-of-network physicians at in-network hospitals and protect patients from bills they didn’t anticipate. It solved the latter problem, but we have seen (and undoubtedly other practices are seeing) that it has been weaponized by the insurance companies to force lower reimbursement. Fortunately, lawsuits filed by the Texas Medical Association are slowly chipping away at that.
So what can be reformed?
Ron and I began a short series this week discussing some of the options that are available to Congress and state legislators. In this episode, we discussed some aspects of House Speaker Kevin McCarthy’s (R-CA) Commitment to America plan and whether or not they would be effective. We also talked about the public option, something President Biden campaigned on in 2020 as an alternative to Medicare for All.
Part two will be available next week.
I have repeatedly brought you stories of the Russians deliberately (other observers may say “carelessly”) attacking civilian infrastructure including hospitals. ABC News provided a good update this week as the war enters its second year. It also tells an interesting story about a lab technician who has agreed to work as a security guard for her hospital as other staff has had to flee because of Russian shelling. Read more in ABC News.
The Food and Drug Administration has been in the news over the past few months and now Congressional legislators are calling for new regulation. Now, you might be surprised to hear that these calls are not in fact about COVID-19 vaccines.
Rather, some are calling on the FDA to reassess how the agency evaluates and reevaluates chemicals that are allowed in food. Currently there are 10,000 chemicals and additives that are permitted in food but many of them are approved and then not addressed again.
Congresswoman Jan Schakowsky (D-IL) has introduced a bill in the House to require the FDA to reevaluate at chemicals and additives that are banned in other countries and close the “generally recognized as safe” loophole.
It’s possible Representative Schakowsky could gain some bi-partisan traction, if she agrees to throw in how the FDA approves vaccines. Republicans are still hung up on COVID-19. If Democrats want the FDA to be stricter on what goes into our food, it wouldn’t be too much of a reach say they should be stricter on vaccines. Whether or not Democrats will be willing to go for that is another question. Read more in CBS News.
Have a good weekend,