Pro-Insurer White House Surprise Billing Rule Angers Providers

Modern Healthcare: Surprise Billing Rule Has Providers Fuming Over Insurer-Friendly Policies
Providers are crying foul about a regulation from the Biden administration that lays out the process they can use to settle out-of-network billing disputes with payers. The rule, released Thursday by the Centers for Medicare and Medicaid Services, is the next step in its implementation of the surprise billing ban passed last year by Congress. Payers praised the regulation as the "right approach," while providers swiftly denounced it as a "miscue" arbitrarily favoring insurers. At issue is the part of the regulation that lays out the independent dispute resolution process used when there is a disagreement between providers and payers over the fair price for an out-of-network service. (Bannow and Hellmann, 10/1)

The Wall Street Journal: Covid-19 Charges At Hospitals Can Vary By Tens Of Thousands Of Dollars, A WSJ Analysis Finds 
The cost of similar Covid-19 treatments can vary by tens of thousands of dollars a patient, even within the same hospital, according to a Wall Street Journal analysis of pricing data that indicates pandemic care hasn’t escaped the complex economics of the U.S. health system. One kind of patient, with a type of severe respiratory condition that is common among those admitted with Covid-19, is an example of the wide range. The rates for these patients usually spanned from less than $11,000 to more than $43,000, the analysis found, but some prices could be far higher, depending on the severity of the case. (Mathews, McGinty and Evans, 10/3)

Modern Healthcare: Rising Air Ambulance Charges Exceed $30,000, Report Finds
Air ambulance utilization and charges have been steadily increasing over the past several years, according to a new study. The average in-network negotiated rate for emergency transport by airplane—excluding mileage charges—rose 76.4%, from $8,855 in 2017 to $15,624 in 2020, according to a FAIR Health analysis of around 35 billion healthcare claims. But most air ambulance rides are out of network, leaving consumers to pay for most of the charges. The average charge associated with airplane ambulances rose 27.6%, from $19,210 in 2017 to $24,507 in 2020. The average Medicare reimbursement rose 4.7% to $3,216 over that span, the same rate increase as emergency helicopter rides. (Kacik, 10/4)

Modern Healthcare: Biden's CMMI Signals New Value-Based Payment Priorities
The Center for Medicare and Medicaid Innovation will take a closer look at value-based payment models, with CMMI's chief operating officer Jon Blum noting that full-risk models can lead to overpayments by federal agencies and penalize providers with more vulnerable patient populations. "I don't think that CMS will be promoting models that have more risk just for the sake of having more risk," Blum said at the National Association of Accountable Care Organizations conference Thursday. (Tepper, 10/1)

In corporate news —

Indianapolis Star: Johnson Memorial Health Struck By Cyberattack Saturday
Johnson Memorial Health says it was a victim of a cyberattack Saturday that disabled its computer network. According to a statement posted on their website, most services at the hospital system are "unaffected." Patients should keep appointments unless they are contacted. "We are currently working closely with our expert cybersecurity partners and law enforcement to investigate this attack and restore normal computer operations as quickly as possible," the statement said. "While we are working quickly to resolve the impact of the cyberattack, we recognize that these situations can take time to fully resolve." (Carter, 10/2)

Modern Healthcare: MD Anderson Names First Chief Data Officer
The University of Texas MD Anderson Cancer Center has appointed Dr. Caroline Chung, a radiation oncologist, as its vice president and chief data officer, effective Friday. Chung is the Houston-based cancer center's first-ever chief data officer. As chief data officer, Chung will be responsible for developing and implementing the organization's data strategy, according to a news release. That includes supervising a data governance and provenance office, as well as working with legal, information security, risk and compliance offices to create policies for how the center's data is used. (Kim Cohen, 10/1)

Houston Chronicle: 'Times Are Changing': Dr. Catherine Gordon Becomes First Woman To Serve As Chief Pediatrician At Texas Children's Hospital
Dr. Catherine Gordon on Friday starts her new roles as chief pediatrician at Texas Children’s Hospital and chair of pediatrics at Baylor College of Medicine, becoming the hospital’s first female chief and one of a few women to helm a major U.S. pediatric institution. She will lead the country’s largest pediatric hospital at a critical time, following the peak of a COVID-19 surge that sickened a record number of children and an out-of-season outbreak of a common respiratory disease known as respiratory syncytial virus. (Gill, 10/1)

Bloomberg: Guardant Health Is Said To Decide Against Buying NeoGenomics
Guardant Health Inc. has decided not to pursue a potential acquisition of rival medical testing company NeoGenomics, according to people familiar with the matter. Guardant had hoped to use a tie up with NeoGenomics as a way to boost its reach into community cancer facilities, typically smaller, local clinics where most cancer patients are treated, the people added, asking not to be identified because the matter is private. (Hammond, 10/4)