UnitedHealth’s Extreme Tactics Upped Medicare Payouts, Senate Inquiry Finds
The Senate report does not accuse UnitedHealth of wrongdoing, but it describes in detail how the company used artificial intelligence and other data-mining techniques to scan patient medical records for new diagnoses and “appears to use all of these mechanisms to the utmost degree." A UnitedHealth spokesman said the company disagreed with the Senate report’s characterizations.
The Wall Street Journal:
UnitedHealth Used Aggressive Tactics To Boost Medicare Payments, Senate Report Finds
UnitedHealth Group deployed aggressive tactics to collect payment-boosting diagnoses for its Medicare Advantage members, a Senate committee investigating the company’s practices said. In Medicare Advantage, the federal government pays insurers a lump sum to oversee medical benefits for seniors and disabled people. The government pays extra for patients with certain costly medical conditions, a process called risk adjustment. (Weaver and Wilde Mathews, 1/12)
On health care workers —
Bloomberg:
Mamdani Joins NYC Nurses On Hospital Walkout Picket Line
Thousands of nurses at three major hospitals in New York City began to strike on Monday, amid a severe flu season and broader pressures on the US health-care system. The walkout impacts roughly 15,000 nurses at hospitals including Mount Sinai Medical Center and NewYork-Presbyterian in Manhattan as well as Montefiore Medical Center in the Bronx. New York City Mayor Zohran Mamdani joined striking nurses on the picket line in Washington Heights. “All parties must return immediately to the negotiating table,” Mamdani said in brief remarks. “They must bargain in good faith.” (Harris and Sapienza, 1/12)
MedPage Today:
How Often Do Physicians Encounter 'Difficult' Patients?
Nearly one-fifth of adult patient encounters in non-psychiatric settings were considered difficult by physicians, a meta-analysis found. The prevalence of difficult encounters was 17% across 10 studies measuring this parameter, Jeffrey Jackson, MD, MPH, of the Medical College of Wisconsin and Clement J. Zablocki Veterans' Administration Medical Center in Milwaukee, and colleagues reported. (Henderson, 1/12)
On nursing homes —
AP:
Massachusetts Enacts Safety Reforms At Assisted Living Facilities After A Deadly Fire
Massachusetts is enacting a series of safety reforms at assisted living facilities including increased inspections and better access to records following a fire last year that killed 10 residents, the governor announced Monday. The recommendations, detailed in a report from the Assisted Living Residents or ARL commission tasked with reviewing the sector, call for annual inspection signed off by the local fire department, board of health and building inspector. It also calls for annual update and review of emergency plans and quarterly emergency exercises with all staff and annual evacuation drills. (Casey, 1/12)
Modern Healthcare:
Low Medicaid Rates Slowing Patient Transfers To Nursing Homes
Hospitals are having trouble discharging patients to nursing homes as those operators receive skimpier reimbursements from state Medicaid programs. Some companies are taking fewer Medicaid patients and more patients covered by higher-paying, fee-for-service Medicare or by private insurance. Others are considering adding special clinical services that provide higher reimbursements for more medically complex patients. (Eastabrook, 1/12)
More health care industry updates —
Modern Healthcare:
Tampa General Hospital, Mass General Brigham Launch Outpatient JV
Mass General Brigham and Tampa General Hospital are launching a joint venture focused on outpatient care. Through the venture, the organizations aim to create an ambulatory care network offering primary care, specialty care, advanced imaging, oncology and outpatient surgical procedures for residents of the east coast of Florida, according to a Monday news release. (DeSilva, 1/12)
Modern Healthcare:
Providence Turnaround Plan May Include Hospital Sales
Providence is considering selling more assets, including potentially some hospitals, as it seeks to streamline operations and improve the health system’s finances, executives said Monday. “We have 51 hospitals, most of which have No. 1 market share in their communities, but we do have a handful that we may have to find a different purpose or different sponsors for,” Chief Financial Officer Greg Hoffman told attendees during a morning presentation at the J.P. Morgan Healthcare Conference in San Francisco. (Kacik, 1/12)
Stat:
As They Brace For Bigger Challenges, Hospitals At JPM Say They’re Going 'Back To The Basics'
At this swanky investor event in the heart of San Francisco’s financial district, the country’s biggest nonprofit health systems usually talk up their money-making prowess and market share. But at this year’s J.P. Morgan Healthcare Conference, held as hospitals stare down historic cuts to Medicaid, the leaders who spoke lacked their normal swagger. Their pitch to investors was decidedly measured, with executives on Monday hammering themes of stability and consistency. (Bannow, 1/12)
CIDRAP:
Stewardship Intervention Fails To Reduce Antibiotic Overuse At Discharge, Trial Finds
An effort to reduce antibiotic overuse in patients being discharged at 10 US hospitals did not achieve its primary goal, according to the results of a randomized trial published late last week in JAMA Network Open. (Dall, 1/12)
