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The Sunshine State, the NSA, and a "Win-Win?"
Friday Pulse Check
Good morning and happy Friday.
The image above is of the Miami skyline. I chose this image in part because our first story takes place in Florida but also as a painful reminder that it is 78 degrees in Miami as I wrote this and only 26 in Detroit.
I bring up Florida because…
Last week an article suggested that states who have their own version of the No Surprises Act (NSA) would be allowed to use their own state laws instead of the Independent Dispute Resolution process (that has yet to be set up) in the Federal law. This suggestion arose when the Centers for Medicare and Medicaid Services announced that they were allowing the State of Florida to adjudicate some disputes for the NSA under their state law. So other states can too, right? Unfortunately, like most things with the Federal government, it is not that simple.
It seems that Florida had requested the CMS to review their state law and see if it would be compatible with the Federal law, possible because there was (and still is) no Independent Dispute Resolution process set up. By the way, that is kind of an important part of the NSA.
Other states, like California and Texas also have their own state version of the NSA, but it is very possible that they won’t seek the same recognition Florida did or that the CMS would even say that their laws are compatible.
There is confusion among many provider groups about how the NSA is supposed to work. We put together a basic explainer this week to address some of those concerns. While it does not address every issue about what the law of the land is currently, it does give you a high-level view of the purpose and the controversy about the law. Read it here.
As we roll into another election cycle in 2022, we decided to look back at a post from last year discussing the pros and cons of Senator Debbie Stabenow’s (D-MI) Medicare at 50 Act. At the time she called it a “win-win” because it would “strengthen Medicare, lower costs and improve care for millions of people.”
While purchasing Medicare would be a cheaper option than employer-based or even Marketplace based health coverage, it would constitute a steep reduction in pay for hospitals and doctors. The CMS said at the time that Medicare pays hospitals, on average, forty percent less than private insurance. When a hospital loses a significant portion of its income, it has to cut costs from somewhere and often times that means staffing shortages among nurses and even emergency care.
Interestingly enough, the NSA seems to be having the same effect, even though that was not one of its original goals. BlueCross BlueShield of North Carolina has already sent letters to over fifty hospital-based groups demanding a reduction in rates or termination from their network altogether.
Regardless, we’re likely to hear about Medicare for All or some iteration of it again as we enter the mid-term elections. We’ll be keeping a close eye on it for you here at FLATLINING and how it can affect your practice and healthcare.
Have a good weekend,