Health Industry Coalition Calls For CMS To Clarify Data Sharing Rules
A coalition of industry groups, which includes the AMA and some insurers, warns that rules over patient data exchanges during prior authorization reviews need to be cleaned up to avoid causing trouble and higher costs. Also in the news: Cigna, Sanford Health, and more.
Modern Healthcare:
AHA, AMA, Insurers Urge CMS To Clarify Data Exchange Rules
Conflicting rules governing patient data exchanges during prior authorization reviews need to be reconciled to avoid confusion and higher costs, a coalition of healthcare industry groups wrote the Centers for Medicare and Medicaid Services on Wednesday. The American Hospital Association, the American Medical Association, the health insurance association AHIP and the Blue Cross Blue Shield Association urge CMS Administrator Chiquita Brooks-LaSure to clear up a mismatch between two proposed rules published in December that mandate different data exchange standards. (Tepper, 7/27)
More health industry developments —
Modern Healthcare:
CMS Payment Rates For Inpatient Rehab, Psychiatric Centers Finalized
Inpatient rehabilitation facilities and inpatient psychiatric facilities will see a bump in Medicare payments next fiscal year. The Centers for Medicare and Medicaid Services issued two final rules Wednesday updating payment rates and quality reporting programs for the two provider types. The changes are effective for discharges beginning Oct. 1, 2023, and lasting through Sept. 30, 2024. (Berryman, 7/27)
Stat:
Ending Health Disparities Requires Full Federal Government, Panel Says
To narrow the nation’s deeply entrenched health disparities, a permanent entity with regulatory powers should be created by the president to oversee health equity efforts across the entire federal government, says a report issued Thursday by the National Academies of Science, Engineering, and Medicine. (McFarling, 7/27)
Modern Healthcare:
Cigna: PxDx Does Not Use AI, Algorithms For Claims Review
The insurer released additional information on its website about its procedure-to-diagnosis, or PxDx, system after two members hit the company with a proposed class-action lawsuit in California federal court on Monday alleging they had been wrongly denied coverage. The lawsuit, filed by Suzanne Kisting-Leung and Ayesha Smiley, came in response to a March report from the ProPublica news outlet that said Cigna’s medical staff rely on an algorithm called PxDx to deny large batches of patient claims without reviewing the individual medical necessity of each case. (Tepper, 7/27)
Modern Healthcare:
Sanford Health, Fairview Health Services Call Off Merger Proposal
Sanford Health and Fairview Health Services have dropped their plans to merge, marking the second failed combination attempt between the nonprofit health systems over the last decade. Health system executives said Thursday in news releases that they couldn’t continue the merger process without the support from certain stakeholders. (Kacik, 7/27)
Modern Healthcare:
Marshfield Clinic, Essentia Health Ink Integration Agreement
Marshfield Clinic Health System and Essentia Health have signed an integration agreement, putting them one step closer to merging, the nonprofit health systems announced Thursday. The combined company would comprise 25 hospitals in Michigan, Minnesota, North Dakota and Wisconsin, a health plan and roughly $6 billion in annual revenue. Marshfield of Wisconsin and Duluth, Minnesota-based Essentia signed a memorandum of understanding in October and expect the deal to close by the end of the year, pending regulatory approval. (Kacik, 7/27)
Stat:
HCA Says Smaller Share Of Spending Going To Labor
The chief executive of the country’s biggest hospital chain said Thursday that labor costs are now lower as a percent of revenue than they were before the pandemic. (Bannow, 7/27)
Stat:
Talkspace Is Budding Into A Digital Health Success Story
Virtual mental health company Talkspace on Thursday added to its run of promising earnings reports, with the once-embattled company continuing to project it would break even by early 2024. (Aguilar, 7/28)
KFF Health News:
His Anesthesia Provider Billed Medicare Late. He Got Sent To Collections For The $3,000 Tab.
Thomas Greene had been experiencing pain in his right leg, a complication from diabetes, when doctors recommended a procedure to increase blood flow to the limb. Retired from a career as an electrician and HVAC technician, he had an outpatient procedure in April 2021 to alleviate his pain by dilating the clogged artery using a balloon snaked into his blood vessel. (Galewitz, 7/28)
KFF Health News:
Bankrupt California Hospital Receives Lifeline From Adventist, Report Says
Bankrupt Madera Community Hospital has received a last-minute lifeline from the hospital chain Adventist Health, which reached a preliminary agreement to take over the shuttered hospital and save it from liquidation, The Fresno Bee reported today. The deal comes as a federal bankruptcy court in Fresno weighs whether to force Madera to sell off its assets to satisfy creditors. The biggest creditor is Fresno’s St. Agnes Medical Center, which walked away from a deal to take over Madera and effectively forced it into bankruptcy. The hospital closed in January. (Weber, 7/27)
KFF Health News:
KFF Health News' 'What the Health?': Another Try For Mental Health ‘Parity’
The Biden administration continued a bipartisan, decades-long effort to ensure that health insurance treats mental illnesses the same as other ailments, with a new set of regulations aimed at ensuring that services are actually available without years-long waits or excessive out-of-pocket costs. (7/27)
