Discover more from FLATLINING from Fulcrum Strategies
One Cigna medical director denied 60,000 claims in a month
Plus: Hospital transparency and news from the Golden State
Good morning and happy Friday. This is the Friday Pulse Check from Fulcrum Strategies; your weekly digest of healthcare news and analysis.
In the news:
Investigation: Cigna uses computer software to automatically deny claims
Late last week, non-profit news organization ProPublica published an investigation into denial habits at Cigna and their use of software that automatically denies claims without physician oversight. They found that one medical director denied 60,000 claims in one month. Our own president and CEO Ron Howrigon was interviewed and cited in the article. If you’re ever wondering why a (logically) routine medical procedure or test was denied, this article could shed some light on your questions. Read more from ProPublica.
A recent survey found that 94% of physicians believe that prior authorization requests delay care. 89% said the practice had a negative effect on patient outcomes with 46% saying it caused an urgent care or emergency room visit. Read more from Becker’s Hospital Review.
FDA approves first over-the-counter Narcan
Naloxone, the opioid overdose reversal drug commonly known as Narcan, has received its first approval from the Food and Drug Administration for its sale without a prescription. The drug is made by Emergent BioSolutions (EBS 0.00%↑) is currently sold in a two-pack form for $70. The manufacturer has not said whether they will continue to sell it over-the-counter for that price. Read more from Politico.
A new study showed that drug overdoses in American seniors have quadrupled in the last twenty years. That study accounts for both accidental and intentional overdoses. The study’s authors said one solution could be for Medicare to cover evidence-based treatments for substance use disorders. Read more in US News.
Hospital price transparency became law in 2021. How many hospitals are complying?
Last week, I shared that Foundation for Government Accountability was suing the Biden Administration for failure to enforce a rule that requires insurance companies to publish their drug price information. I am skeptical of that lawsuit because I think there are greater transparency issues that need to be addressed first, namely the Qualified Payment Amount in the No Surprises Act. Another of those issues is the hospital price transparency law, which Ron and I have talked about on the podcast before. We were and are skeptical that it will not do anything to lower healthcare costs because many people are not going to pay the chargemaster rate and in emergency situations, no one is going to stop and take a look at which hospital costs less. Anyway, it is the law and the Biden Administration has failed to enforce it too. Kaiser Health News took a look at how many hospitals are complying and found that 70% of hospitals have published priced lists in 2022. Read more in Kaiser Health News.
Other articles of interest:
The FLATLINING Podcast
This week on the podcast, Ron and I took a look at several healthcare news articles in the state of California. In the healthcare world, California has always been a special case study. The state has attempted to pass its own version of single payor healthcare several times, they have strange laws about how claims can be processed in their state, and they continue to have one of the highest costs of living anywhere in the country.
In this episode, we talked about California’s recent decision to sever ties with pharmacy retail giant Walgreens (WBA 0.00%↑), a decision we said was largely political and will likely not do anything to affect the bottom line of the international corporation.
Additionally, the state has announced it will begin selling California-branded insulin to anyone in the state. It is their attempt to lower the cost of that drug for the millions of diabetics living in California.
Keep in mind that California governor Gavin Newsom is itching to run for president and he is working on setting up the right Democratic record to make him palatable on a national stage. He may have a winning strategy here. The question remains: will he run in 2024 or 2028?
In a recent press conference with the World Health Organization, health officials in Ukraine and from the WHO said that nearly 50% of people living in the war-torn country require some form of rehabilitation. You can watch the conference below:
Technology has, without a doubt, made our lives easier and our work more efficient; healthcare is no exception. But, it also leads to a greater risk of compromise or computer errors.
When former President Donald Trump and other Republicans were pushing their theories that the election was stolen, they also campaigned that elections should be done on pen and paper and hand-counted to avoid computer errors. Studies have shown that computer counting is more accurate than hand counting.
Some have advocated for the same with healthcare. They say that if you want to have protected health information locked up tight, it cannot be online or available digitally. However, that would significantly slow physicians’ and patients’ ability to get quality care quickly. Of course, it comes with risks.
In this week’s HIPAA Violation of the Week, Oklahoma University Health is warning patients that some protected health information may have been compromised after an employee’s laptop was stolen last year. Some of the information that may have been compromised is social security numbers, diagnoses, and treatment information.
It appears the hospital is doing everything that is required by law to rectify the issue. I do think it is vitally important to keep patient information secure and private, but I also believe that the benefits outweigh the costs when it comes to storing protected health information on the cloud or on hospital computer systems. Read more from OU Health.
Have a good weekend,