Big Health Insurers Plan Legal Battle Over Biden Medicare Advantage Audits
Stat reports that at the J.P. Morgan Healthcare Conference, Humana, Centene, and CVS Health-Aetna executives explained concerns over upcoming final rules on audits, also known as risk adjustment data validation. Meanwhile, the New York nurses strike entered a second day, among other news.
Stat:
Insurers Hint At Suing Over Plans For Medicare Advantage Audits
Big health insurers who spoke at the J.P. Morgan Healthcare Conference are gearing up to battle the Biden administration once it finalizes its plan for auditing Medicare Advantage, which is expected to happen next month. (Bannow, 1/10)
On the nurses strike in New York —
The New York Times:
Nurses Strike At Mount Sinai And Montefiore Extends For Second Day
Hundreds of nurses, wearing their bright red union hats and scarves, marched outside both hospitals Tuesday morning to call for improved wages and more nurses to care for patients, chanting, holding signs and blowing air horns. Inside the hospitals, a skeleton staff cared for reduced patient loads. The nurses said they worried that patient care was suffering inside, but that improving patient safety in the long term was one of the main reasons they went on strike. (Otterman, 1/10)
Politico:
1199 SEIU Tells Montefiore To Stop Sending Its Members To Fill In For Striking Nurses
The health care union 1199 SEIU sent a cease-and-desist letter Tuesday to Montefiore Medical Center, alleging that management is involuntarily sending licensed practical nurses represented by that union to work at its Bronx hospital campuses where members of the New York State Nurses Association are on strike. (Kaufman, 1/10)
CNN:
Nurses Strike: Mount Sinai NICU Mom Stays By Her Son's Side In Hospital After His Primary Nurses Leave To Strike
Lora Ribas hasn’t left her son’s bedside in four days. Her one-year-old baby, Logan, has been in the neonatal intensive care unit (NICU) since he was born. For the past three and a half months, he’s been under the care of Mount Sinai Hospital where thousands of nurses are currently striking. (Tebor, 1/10)
Meanwhile, hospitals say labor costs may have peaked —
Stat:
Hospitals Say Peak Labor Costs Are Behind Them
Rising labor costs have been the main financial concern for hospitals over the past year, but those costs have peaked and are now a lot lower, according to hospital system executives who presented during the J.P. Morgan Healthcare Conference. (Herman, 1/10)
In other industry news —
Axios:
CVS Health Is On A Shopping Spree
CVS Health is exploring a takeover of Chicago-based Oak Street Health, a Medicare-focused operator of a network of value-based primary care centers, per Bloomberg. A deal could be valued north of $10 billion, including assumed debt. (Primack, 1/10)
Reuters:
Abbvie Raises Sales Outlook Of Two Immunology Drugs To More Than $17.5 Bln In 2025
AbbVie Inc on Tuesday raised its 2025 sales forecast of its newer immunology drugs Skyrizi and Rinvoq to more than $17.5 billion as it hopes to replace the loss of revenue from its blockbuster rheumatoid arthritis drug Humira. The company's previous sales outlook for Skyrizi and Rinvoq in 2025 was more than $15 billion. (1/10)
Modern Healthcare:
J.P. Morgan 2023 Healthcare Conference Live Updates, Day 2
Health Catalyst has pivoted its strategy as its health system customers focus less on long-term return on investment. (1/10)
Also —
KHN:
The Decision Of Where To Seek Care Is Complicated By The Multitude Of Options
One evening in February 2017, Sarah Dudley’s husband, Joseph, started to feel sick. He had a high fever, his head and body ached, and he seemed disoriented, she said. The Dudleys had a decision to make: go to the hospital emergency room or to an urgent care clinic near their home in Des Moines, Iowa. (Whitehead, 1/11)
KHN:
Listen: Who Investigates Suspicious Deaths In Your Community — And Why It Matters
Each state has its own laws governing the investigation of violent and unexplained deaths, and the expertise and training of those in charge of such investigations vary widely across the nation. The job can be held by an elected coroner as young as 18 or a highly trained physician appointed as medical examiner. (1/11)
