Opaque Transparency
Friday Pulse Check
Good morning and happy Friday. Welcome to the Friday Pulse Check.
In the news:
What does it mean to be transparent?
Cigna (CI 0.00%↑) and UnitedHealthcare (UNH 0.00%↑) have finally released some of the data regarding their contracted rates that they were obligated to share under the No Surprises Act. Don’t get me wrong, it is very good we now have data. The problem is (and big surprise here), the payors are doing IT gymnastics to make it as difficult as possible to read. Cigna even put a disclaimer on their website that some of the files could be as much as one terabyte of data. For my non-tech friends out there, that requires more space than my laptop can handle. So perhaps I should coin a new term; what we are experiencing from the payors is “opaque transparency.” For the average person, it is sort of likely trying to make out the problem through a dirty window. You can just kinda see it, but not enough to make sense of it. Now yes, technically the payors have been transparent with their data but at the same time they have made it incredibly difficult to decipher. Thus, opaque transparency. We (as many others, I’m sure) will be taking a look at this data and reporting on it. Read more from FLATLINING.net.
Even good laws can’t solve inaccurate provider directories
It is very good that we have all this opaque transparency from the No Surprises Act but there is still a problem that is a bane for both physicians and patients alike: inaccurate provider directories. Last week, I shared data about just how many people look at prices before seeing a doctor or having a procedure. Of those people, 60% of them looked to their insurance company to share that information. As I said then, this makes sense because the insurance company is the one determining how much the patient will pay. But, if their directory is inaccurate, they could be walking into an office not realizing that it isn’t in their network. Read more from FLATLINING.net.
New drug pricing bill limits HHS
The Democrats’ new bill that would allow Medicare to negotiate drug prices for those enrolled in that program would limit HHS so it can only negotiate prices on twenty drugs a year. It also only allows negotiation for drugs that have been approved by the FDA for several years (9 for small-molecule drugs and 13 for biologics). It is an interesting compromise likely in the hopes to gain enough bipartisan support to pass the 50-50 Senate. Read more from Axios.
The Colorado Option
This week on the FLATLINING Podcast, Ron and I took time to discuss the State of Colorado’s answer to the public option. In short, we are not fans and Ron even suggested that it might end up at the Supreme Court. This is due to a safety net in the law that ensures it will work.
In the law, insurance companies are required to create a plan and sell it to all individuals and small businesses. This plan has to meet targets for premium reductions; one of the requirements is that the premium in 2025 must be 15% lower than what it was in 2021 plus adjustments for inflation. When (not if, but when) the insurance companies aren’t going to be able to do that (either because doctors won’t take that much of a pay cut or won’t sign on to the plan to start with), the State of Colorado will pressure doctors and hospitals to join the option plans and take the pay cut.
Now, Colorado won’t mandate that doctors and hospitals join the plan; that would be a violation of the commerce clause. But what they might do is tell the doctors and hospitals (particularly the university hospitals that receive state funding) that they will not be eligible for grants or funding from the state or that they cannot participate in the Medicaid program. While not technically a violation of the commerce clause, one could argue it violates the spirit of the law. That’s the part that might end up at the Supreme Court. We’ll see.
Ron and I also discussed whether or not Medicare reimbursement will be cut by 4.4% in 2023 and what physicians and hospitals should do to prepare. We also discussed the role healthshares play in our healthcare system and what happens if one of them fails to work.
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Ukraine
Four burn surgeons and one anesthesiologist from Ukraine are participating in an exchange program and working at Akron Children’s Hospital on a ten-day visit sponsored by the Congressional Office for International Leadership. They also visited the Akron Fire Department and Northeast Ohio Medical University. They shared their stories about the kinds of burns they’ve been treating recently in Ukraine. Read more from the Akron Beacon Journal via Yahoo Entertainment.