- The AMA’s Advancing Health Equity guide is a joke. But after the laughter dies, it is also very sad.
- British Columbia to send thousands of Canadian cancer patients to Washington state for treatment.
- Paragon: Medicare’s venture into “value based care” has done little except add administrative burden and a set of quality metrics that are easily gamed and don’t translate into better or more efficient care.
- Trump’s executive order allowing employers to fund individually owned health insurance is taking hold.
Category: Policy & Legislation
Addicted to Drug Money: States Not Spending Opioid Settlement Funds on Addiction Treatment
In was the dawn of the 21st Century when untreated pain became a public health priority. In 1990 Dr. Mitchel Max, then president of the American Pain Society, authored an editorial in the Annals of Internal Medicine lamenting the lack of progress treating pain over the previous two decades. Within a few years Joint Commission jumped on the bandwagon and published Pain: The Fifth Vital Sign. Thus began America’s experiment in aggressive pain treatment and its descent into opioid addiction and overdose deaths.
Meet Your New Primary Care Physician: MegaCorp
Large corporations are buying primary care physicians’ practices in droves. CVS bought Oak Street, while Amazon bought One Medical. Primary care is rather mundane as physicians’ practices go. So why are hospitals, insurers and pharmacy chains scooping up primary care practices?
The appeal is simple: Despite their lowly status, primary care doctors oversee vast numbers of patients, who bring business and profits to a hospital system, a health insurer or a pharmacy outfit eyeing expansion.
And there’s an added lure: The growing privatization of Medicare, the federal health insurance program for older Americans, means that more than half its 60 million beneficiaries have signed up for policies with private insurers under the Medicare Advantage program. The federal government is now paying those insurers $400 billion a year.
Clash of the Titans: Emergency Staffing Firm Battles Insurer and Physicians
Envision Healthcare is one of the largest physician staffing firms in the country. It was taken private in a $5.5 billion deal in 2018. It sued insurer UnitedHealthcare for underpayment of emergency room services, recently winning a $91 million judgement.
Envision CEO Jim Rechtin alleges UnitedHealthcare routinely denied claims for commercial members who were among the sickest and sought care at an emergency room. Rechtin called UnitedHealth’s alleged practice “cold, callous and inhumane,” according to a statement released Friday announcing a lawsuit was filed in a Tennessee federal court.
UnitedHealthcare countersued Envision for allegedly exaggerating patient claims and padding their bills.
UnitedHealthcare alleged Envision, one of the largest physician staffing firms in the U.S., has “systematically deceived” the insurer into overpaying through a practice known in the industry as “upcoding,” according to a lawsuit filed in a federal court in Tennessee on Friday.
Upcoding is a common practice that is hard to prove and harder to eradicate.