Cumbersome Claim Policies Irk Health Care Providers: ‘Everything Is A Fight’
Modern Healthcare looks at the measures health insurance companies are using for reviews, including one that would charge providers who appeal rejected claims. Also in the news: fee inequality, anesthesia investments, health system layoffs, and more.
Modern Healthcare:
Claims Denials See More Barriers From Insurers: Providers
Healthcare providers say insurance companies are innovating new ways to make it harder to get paid. Physicians, hospitals and other providers have always complained of low rates, delayed payments and the usual red tape. But rules insurers such as Blue Cross Blue Shield of Michigan, UnitedHealthcare and Elevance Health have recently announced may be a new battleground in the age-old fight between the two camps. (Tepper, 1/22)
Fierce Healthcare:
Hospital, PE-Affiliated PCPs Demand Higher Prices, Study Finds
Negotiated professional fees are lower among primary care physicians practicing in independent settings than for those who are affiliated with hospitals or private equity, according to a recent study. The analysis headed by Brown University School of Public Health researchers reviewed evaluation and management office visit charges from 2022 as negotiated by Aetna, Blue Cross Blue Shield, Cigna and UnitedHealthcare. In total, the group reviewed 226.6 million prices from about 198,000 primary care physicians (PCPs) as well as changes in those physicians’ ownership over time. (Muoio, 1/22)
The Guardian:
Indiana Bill Seeks To End Tax Breaks For Non-Profit Hospitals That Overcharge Patients
Indiana lawmakers are pushing to slash hospital prices after a Guardian investigation chronicled how one of the state’s largest non-profit hospital chains bought up its competition and used its market power to stick patients with some of the highest bills in the country. A new bill introduced last week in the Indiana general assembly would strip non-profit hospitals of their tax-free status if they continue to charge commercially insured patients more than 200% of what the federal government pays for the same services under Medicare. (Joseph, 1/22)
MedPage Today:
FTC Settles With Private Equity Firm Over Anesthesia Investments
Last week, the Federal Trade Commission (FTC) announced a settlement with the private equity firm Welsh, Carson, Anderson & Stowe (WCAS), resolving a potential administrative antitrust case. The FTC had alleged that WCAS -- through its portfolio company U.S. Anesthesia Partners (USAP) -- engaged in acquisitions to "suppress competition and drive up prices" for anesthesiology services in Texas. Now, under a proposed consent order, WCAS will be required to limit its involvement with USAP and notify the FTC of future acquisitions and investments in anesthesia services and other hospital-based physician practices. (Henderson, 1/22)
Modern Healthcare:
CMS Appeals UnitedHealth's Medicare Advantage Ratings Win
The Centers for Medicare and Medicaid Services has appealed a federal judge's order to recalculate UnitedHealthcare’s Medicare Advantage Star Ratings. Regulators submitted their notice to appeal to the U.S. District Court for the Eastern District of Texas on Tuesday. CMS' notice did not state the grounds for its appeal. (Tepper, 1/22)
More health care industry updates —
Modern Healthcare:
Jefferson Health, Lehigh Valley Health Layoffs Hit 271 Workers
Jefferson Health and Lehigh Valley Health Network plan to lay off 271 workers. Two separate rounds of layoffs are not tied to the merger that closed in August, representatives from Jefferson and Lehigh Valley said. The combined system includes 32 hospitals and more than 700 locations. The layoffs amount to roughly 0.4% of the combined workforce of 65,000. (Kacik, 1/22)
CBS News:
Sharon Regional Medical Center To Reopen After Court Settlement
More than two weeks after Sharon Regional Medical Center closed down, the Mercer County hospital will soon start serving patients again. It's unclear exactly when the hospital is expected to reopen. A spokesperson for Medical Properties Trust, the company that owns the building, tells KDKA-TV that "[they] look forward to seeing operations resume successfully in the coming days." (Linder, 1/22)
The Boston Globe:
Proposed Nashoba Valley Emergency Room Would Replace Shuttered Steward Hospital
Four months after Steward Health Care shuttered its hospital in the Nashoba Valley area as part of its bankruptcy process, health care officials are considering opening a new, stand-alone emergency room in the region, officials said Wednesday. UMass Memorial Health said it plans to build and operate the emergency department, which is also expected to offer certain imaging services. “We believe this solution can fill the community’s critical needs and address their primary areas of concern,” the hospital group said in a statement. (Fonseca, 1/22)
