NSA Update: Judge throws out $350 admin fee for IDR
NSA Update: Judge throws out $350 admin fee for IDR
Plus: Estimates are everywhere, not just in healthcare
Good morning and happy Friday. This is the Friday Pulse Check from Fulcrum Strategies and FLATLINING.net where we keep track of the important healthcare stories, so you don’t have to.
In the news:
TMA 4 ruling is a win for physicians
This week, Judge Jeremy Kernodle release his ruling on the fourth lawsuit by the Texas Medical Association against the federal government. This lawsuit, commonly known as TMA 4, took the federal government to court over the decision to raise the fees to send claims to the Independent Dispute Resolution process from $50 to $350. It also now does not require providers to bundle claims based on employer. Judge Kernodle ruled that the federal government did not follow proper procedure implementing the rules, meaning it did not have a proper comment and notice period. He also added, however, that the other arguments made by the Texas Medical Association were compelling. TMA was arguing that the fee hike was arbitrary and capricious. Judge Kernodle likely added this to warn the federal government that they cannot just turn around and follow the rules because he will rule that they are arbitrary and capricious.
We can probably expect a ruling on TMA 3 in the next week or so. What we have been hearing from our sources is that Judge Kernodle was not happy TMA 1 was taken to an appellate court and so he is writing his ruling in a way that would make it very difficult for a higher court to strike it down.
In memoriam: Dr. Dan Hurley
Late last week, I received word that Dr. Dan Hurley, who we interviewed on the FLATLINING Podcast, had lost his battle with cancer. Dr. Hurley was honest with us in his interview that he didn’t expect to be able to do it again in a year. Our own president and CEO, Ron Howrigon, wrote yesterday about how Dr. Hurley’s story affected him and why he, and all of us at Fulcrum Strategies, work as phyisican advocates. We will have it pinned as the main story on our home page through Wednesday next week.
Other articles of interest:
Novo Nordisk to buy Inversago Pharma for $1 billion - Novo Nordisk
LIVE Novo Nordisk stock price: NVO 0.00%↑
SCOTUS temporarily blocks Purdue Pharma’s $6 billion opioid settlement - The New York Times 🔒and Becker’s Hospital Review
UK’s Competition and Markets Authority OKs UnitedHealth Group’s purchase of health tech company EMIS Group - Becker’s Payer Issues
Live UnitedHealth Group stock price: UNH 0.00%↑
UnitedHealth Group could be worth $1,000,000,000,000 ($1 trillion) by 2030 - The Motley Fool
Half of Medicare Advantage beneficiaries say they don’t understand their plan - Retirement Living
HIPAA Violation of the Week: At least 21 hospitals facing lawsuits over Meta and Google trackers - Becker’s Health IT
LIVE Google stock price: GOOGL 0.00%↑
LIVE Meta stock price: META 0.00%↑
The FLATLINING Podcast
This week on the FLATLINING Podcast from Fulcrum Strategies, Ron and I discussed a recent claim made by Senator Bernie Sanders. He said that millions of Americans are unable to access a primary care physician. Are his claims true? Well it depends on how you define access.
Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.
Ukraine
For over a year now, I’ve shared with you stories of determination to keep healthcare delivery systems functioning in Ukraine amid the invasion by Russia. This week, I am sharing with you a summary story of the many efforts that have been undertaken to provide care to Ukranian patients. Many of these patients are not immediate victims of the war, but have chronic health conditions, like people in any other country, who are increasingly unable to get the care they need. Read more from The New Humanitarian.
Final Thought
This week, National Public Radio and KFF Health News published an article describing a new ad campaign from Power to the Patients. In the ad, it describes a society where there are no longer published prices for anything, and instead everything is based on the “hospital pricing method.” They claim that this is an estimate and then bill customers whatever they want.
Now, I know because I work with healthcare providers that it is next to impossible to provide an actual price for healthcare service. First, if a patient has insurance there is little to know way of knowing what their responsibility is going to be when they show up at the doctor’s office; the only real way to know is after their insurance company processes the claim.
Second, what happens when a patient comes into an office for one issue and his or her doctor finds a significantly more pressing issue that needs immediate testing? There is no way to include something like that in an estimate.
Whether we like it or not, estimates are already common in our economy. I get estimates from electricians, mechanics, and custom printing shops. So this idea that is unique to healthcare and a way for providers or hospitals to rip off patients is absurd.
You can watch the ad below for yourself and let me know what you think in the comments or on X (formerly Twitter); I’m @radioHandley.
Have a good weekend,
Matthew