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The unveiling of a new federal rule last week to prevent “surprise” medical bills is worth covering on its own merit. The expected lobbying battle about this rule also could provide a good news peg for digging into one of the key debates about what’s causing the cost of health care to continue its rise in the U.S.
At the heart of recent battles over surprise bills is the question of how much insurers should pay for out-of-network medical care.
The Biden administration’s rule leans toward using payment rates already established within insurers’ networks in resolving disputes about out-of-network care. Known as the qualifying payment amount (QPA), this benchmark is pegged to the median contracted rate. Other factors may be considered in resolving payment disputes, but QPA is described as something akin to a stand-in for an “appropriate” out-of-network rate in the rule. Continue reading
With so much focus — and rightly so — on COVID-19, it’s understandable that even the best health care journalists have overlooked a critically important patient safety story, one that few I know had even heard about.
On April 5, 2021, the federal Information Blocking rule went into effect, allowing basically anyone who provides health care, “defined as “actors,” to release electronic health records in 16 categories such as summary visit notes, lab and pathology reports, and imaging studies to the patient’s health portal as soon as they are available electronically. According to the rule, that means even before the doctor has had a chance to review them, and before the provider has had a chance to explain or discuss what’s in those documents with the patient. Talk about a huge culture shift. Continue reading
EDITOR’S NOTE: This is the second in a series about the Biden Administration’s efforts to increase COVID-19 vaccination rates among nursing home workers. For the first story see: Federal funds at stake as Biden Administration seeks to require vaccines for nursing home workers
The Biden administration likely will face challenges in trying to implement a planned mandate for COVID-19 vaccinations for staff of nursing homes, despite efforts to portray this proposal as a done deal. Continue reading
Is a new push by the Biden Administration to increase COVID-19 vaccinations among nursing home workers the right approach? While patient, resident and industry advocates are mostly supportive, others are alarmed by even the vague outline of the rule recently announced by the Centers for Medicare and Medicaid Services (CMS).
President Biden asked CMS to issue an emergency declaration on August 18 to mandate that workers at the nation’s more than 15,000 nursing homes that receive Medicare and Medicaid dollars get the COVID-19 vaccine or put the facility’s federal funding at risk. Continue reading
Editor’s note: This is the second of two articles on reframing the debate about low-benefit treatments. Part one published on Thursday, August 19.
The legacy of racism in medicine may make patients wary of physicians who attempt to dissuade them from treatments and tests considered likely to offer little or no benefit, according to the authors of a May article in Health Affairs, “Time To Set Aside The Term ‘Low-Value Care’ — Focus On Achieving High-Value Care For All.”
Better to scrap the term “low-value care” and start over with language emphasizing the need for equitable access to care and treatment of Black and Latino people, wrote the authors, Danielle J. Brooks, director for health equity at AmeriHealth Caritas; Carmen E. Reyes, the community outreach director for the UCLA Value-Based Care Research Consortium, and Alyna T. Chien, an assistant professor at Harvard Medical School. Continue reading