Insurers Increasingly Cut Payment For Consultation Codes

Modern Healthcare: More Insurers Cut Payment For Patient Consultations
Health insurers Anthem and Aetna began denying providers' claims that include consultation codes this year, joining the growing ranks of payers cutting reimbursement amid an industrywide coding change. Consultations are a type of evaluation and management service provided at the request of another physician. For example, a primary care physician may refer a patient to a cardiologist. The specialist would then examine the patient, offer an opinion and send the individual back to the primary care provider for treatment. The cardiologist in this case would bill for the visit using a consultation code. (Tepper, 3/21)

In news about health care personnel —

Fox News: Covid Pandemic Takes Toll On Key Medical Support Community
The pandemic has not only contributed to a shortage of home health aides but also affected the medical equipment industry, home health equipment suppliers told Fox News. This has created problems for individuals who need equipment servicing for wheelchairs, home oxygen equipment, ventilators and more, according to some home health agencies.  Anecdotal reports of home care equipment personnel shortages said without equipment specialists, vulnerable seniors are forced into nursing homes and left struggling with how to adjust or service their own equipment. (McGorry, 3/21)

Detroit Free Press: Michigan Facing Shortage Of Primary Care Physicians
Michigan is experiencing a decline in the number of primary care physicians, with more shortages expected by 2030, particularly impacting residents in underserved areas. The shortages can be curbed, in part, by beefing up state funding for existing programs to recruit, train and retain physicians in that field, a group of family medicine physicians said Monday. Michigan has 269 health professional shortage areas, where either the proportion of family physicians and primary care physicians is too low or there are no primary care physicians whatsoever, according to Kaiser Family Foundation data, said Dr. Jennifer Aloff, a family physician at Midland Family Physicians. (Hall, 3/21)

The New York Times: Concussions Doctor Under Scrutiny In Plagiarism Scandal 
For more than two decades, Paul McCrory has been the world’s foremost doctor shaping the concussion protocols that are used by sports leagues and organizations globally. As the leader of the Concussion in Sport Group, McCrory helped choose the members of the international group and write its quadrennial consensus statement on the latest research on concussions — a veritable bible for leagues, trainers, doctors and academics that an N.F.L. spokesman once called “the foundation of all sports-related research.” (Belson, 3/21)

Miami Herald: State Complaint Says Tampa FL Doctor Did Wrong Site Surgery 
Asking the patient to confirm where a cancer surgery should be performed after the patient had been given a sedative led to a Tampa area doctor performing a wrong site surgery, a state complaint said. The administrative complaint against the license of Safety Harbor doctor Robert Davidson starts the discipline process. Davidson’s online Florida Department of Health license profile shows no previous disciplinary actions against the license he’s held in Florida since 2002. An email from the Miami Herald to the address on his profile was not returned. (Neal, 3/21)

KHN: As A Nurse Faces Prison For A Deadly Error, Her Colleagues Worry: Could I Be Next? 
Four years ago, inside the most prestigious hospital in Tennessee, nurse RaDonda Vaught withdrew a vial from an electronic medication cabinet, administered the drug to a patient, and somehow overlooked signs of a terrible and deadly mistake. The patient was supposed to get Versed, a sedative intended to calm her before being scanned in a large, MRI-like machine. But Vaught accidentally grabbed vecuronium, a powerful paralyzer, which stopped the patient’s breathing and left her brain-dead before the error was discovered. (Kelman, 3/22)

In other health industry news —

Columbus Dispatch: Hospital Mergers: Health Care Costs Rise, Patients Suffer, Studies Say
If you need to go to the hospital in Ohio these days, your choices are dominated by a handful of multibillion-dollar medical systems. The state's seven largest medical systems run a combined 58 community hospitals – more than 40% of the total – American Hospital Association statistics for 2019 show. Add in a variety of other medical facilities and doctors offices, and these seven systems occupy nearly 1,100 locations across the state, according to an analysis by The Columbus Dispatch, part of the USA TODAY Network. Leaders of these systems say health care consolidation means better, more cost-effective care and improved access to specialists for patients of once-independent hospitals. (Rowland, 3/22)

Anchorage Daily News: The Historic Split Of Alaska’s Massive Health Department Is Now Law. What’s Next?
Dunleavy said during a media briefing Monday he thought that the split would “drive down costs over, we think, a short period of time.” “The idea is that with better oversight and better focus, that we will get better outcomes,” he said, later saying the success of the split will be measured based on staff and public feedback as well as data like staff turnover and vacancy rates. The reorganization was designed to minimize disruption to people using the department’s services, officials say. The new Department of Health contains divisions aligned by payment to include those taking Medicaid: Public Health; Public Assistance; Behavioral Health; Health Care Services; and Senior and Disabilities Services. (Hollander, 3/21)

AP: Reno's Newest Hospital On Track To Open This Spring 
A new full-service hospital in Reno is poised to open this spring. The Reno Gazette-Journal reports a pre-opening event on Monday will show select guests the progress of Northern Nevada Sierra Medical Center. CEO Alan Olive says the hospital received its certificate of occupancy. So, equipment can now be moved into the facility. (3/21)

Bloomberg: Health Insurance Startup Raising Funds At $2.7 Billion Valuation
Digital health-insurance startup Alan is in talks to raise new funding with a valuation about 2.5 billion euros ($2.7 billion), according to people familiar with the matter. The round isn’t finalized yet and the details could change, the people said, who asked not to be named discussing private information. A spokesperson from Alan declined to comment. Paris-based Alan last raised 185 million euros in April 2021 at a 1.4 billion-euro valuation from investors including Coatue Management, Temasek and Index Ventures. Other backers include Exor NV, the holding company of Italy’s billionaire Agnelli clan, and Dragoneer, an early backer of Spotify. (Levingston and Berthelot, 3/21)

Stat: How A Team Effort To Improve Health Care With The Help Of AI Paid Off
The project began with a vexing problem. Imaging tests that turned up unexpected issues — such as suspicious lung nodules — were being overlooked by busy caregivers, and patients who needed prompt follow-up weren’t getting it. After months of discussion, the leaders of Northwestern University’s health system coalesced around a heady solution: Artificial intelligence could be used to identify these cases and quickly ping providers. If only it were that easy. (Ross, 3/21)