WakeMed goes non-par with UHC
Friday Pulse Check
WakeMed goes non-par with UnitedHealthcare
Friday Pulse Check
Good morning and happy Friday. This is your weekly dose of news and analysis from FLATLINING.net which we call the Friday Pulse Check.
In the news…
Pfizer seeking authorization for its COVID-19 vaccine for children under five
The Wednesday filing with the US Food and Drug Administration showed that three lower-dose shots of the vaccine generated a strong immune response in children as young as six months. This comes after Moderna sought approval for their vaccine in children under five back in March. No COVID-19 shots have been approved yet for children under five.
Police: Pain was the motivator behind the shooting in Oklahoma
On Wednesday (a week after the Uvalde, TX shooting), a man shot and killed Dr. Preston Phillips and three others before killing himself. Police have said that the man specifically targeted Dr. Phillips, who had recently performed surgery on his back. As doctors work to prescribe alternatives to opioids for pain management, surveys show that more and more of them seem to be facing threats of violence. In a 2019 meeting at the American Academy of Pain Medicine, more than two-thirds of doctors say they were threatened with bodily harm, and over half said it was over opioids. Investigators, in this case, have not said that he was seeking opioids from Dr. Phillips, but that his addiction to the medication was the “driving factor” behind the shooting.
Melatonin poisonings are up in kids
Last year, US poison control centers received more than 52,000 calls about children consuming worrisome amounts of the dietary supplement, up six-fold from 2001. Melatonin has become a popular over-the-counter supplement and its sales have increased 150% from 2016 to 2020. Melatonin is not classified as a drug, but rather as a supplement. Because it is not a drug, the US FDA does not have regulatory or oversight power over the purity of its ingredients. Moral of the story: keep medicines and supplements stored in your medicine cabinet and read the directions and warning labels before you give them to your children.
Private equity in healthcare
This week on the FLATLINING Podcast, Ron and I discussed the ways private equity money has been making its way more and more into healthcare. After a recent series of articles and news stories detailing the “horrors” that this is bringing into our healthcare system, we wanted to set the record straight and take an honest approach to the matter.
Quite frankly, as Ron proposed, it is possible that private equity involvement in healthcare delivery (which is the new phenomenon that we are seeing) may actually increase the quality of care that patients receive. Why? Because private equity is interested in increasing profitability, they are interested in increasing the quality of the care they can provide. “Wouldn’t that lead them to cut corners?” You’d think so, but there isn’t any evidence of this yet in healthcare delivery. In health insurance, it is obvious what happens to PE-backed insurance that cuts corners; look at Bright Health.
Ron and I also discussed new data showing that three in ten Americans still believe some form of misinformation about COVID-19 vaccines and pregnant women. We also talked about what happens when hospital residents go unionize and go on strike.
Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, and Audible.
WakeMed goes non-par with UHC
It was reported earlier this week that WakeMed, a large hospital delivery system in central North Carolina went non-par with UHC. This gem of a story from local TV station WNCN leaves much to be desired in their reporting.
The article starts off decent, saying that the two groups have negotiated for months. It has a quote from WakeMed and then a quote from UHC and then it has a quote from a patient who is a UHC member. Apparently, this is the limit of what they are teaching in journalism schools.
What WNCN fails to do is explain why practices are willing to go out-of-network, why they negotiate to begin with, and why organizations like UHC would let large delivery systems out of network.
I want to start by disclosing that Fulcrum Strategies does not represent WakeMed nor do we have any knowledge of what went on through the negotiations; this is pure speculation.
Practices threaten the insurance companies with terminations frequently during the negotiation process. If they didn’t, the payors wouldn’t even step up and negotiate. If a hospital delivery system thinks they are being compensated below what they should be (or if a payor is significantly lower than other payors) they might go to that payor with a proposal. When the payor says they’re not going to negotiate, that’s when they hand in a termination notice.
In their statement, UnitedHealthcare said that WakeMed did not respond to many of the counter-proposals from UHC. Good on WakeMed for sticking to their guns.
I also want to take a few moments for a lightning-round response and pick apart UHC’s ridiculous statement on the matter. This is where I will give kudos to the reporter at WNCN for not using some of these lines as clickbait.
UHC said that because WakeMed refused to agree to their counter-proposals, they “can only assume it was always the health system’s intent to disrupt access to care for North Carolinians.” I think it is safe to assume that UHC didn’t want to hurt the record profits that it has been raking in over the past two years. Additionally, this is just the tired cliché from the insurance companies and the Medicare-for-all folks who think doctors are rich and greedy and will do anything for money. It is nonsense.
UHC is also complaining that WakeMed wants to have some control over where their patients get care and drugs. Let’s be clear: this isn’t about WakeMed being controlling, it’s about UHC wanting the cheapest healthcare possible.
Finally, UHC disclosed what WakeMed’s demands were. They claim WakeMed wants a 20% increase from what they are getting now. UHC claims this will just raise the cost of healthcare for North Carolinians. In reality, it is little more than a rounding error in their $3.8 billion in operating earnings in just the first quarter of this year.
On that note, here is a totally serious video about what actually happens at UnitedHealthcare:
This time our Ukraine story has a domestic twist. Russia and Ukraine are major suppliers for certain commodities, particularly ammonium nitrate and natural gas. In the healthcare world, these are used to make nitrous oxide (aka laughing gas) and helium. These are used in millions of procedures every day. Kaiser Health News is reporting on how this can make root canals and MRIs pricier.
Have a good week,