A survey by UPMC's Center for Connected Medicine finds enthusiasm for the idea.
Most healthcare executives believe that artificial intelligence could be tapped to identify and recruit patients for clinical trials, according to a survey by UPMC's Center for Connected Medicine (CCM).
The survey of 58 payer and provider senior executives -- many of whom specialize in AI and analytics, and more than half of whom work at larger hospitals and academic medical centers -- was compiled in February and published this week in a CCM report.
"Clinical trials are an important part of providing life-changing care to our patients. However, it can be a significant challenge to match patients to studies," says Oscar Marroquin, MD, chief healthcare and data analytics officer at UPMC, and a founding partner of the CCM. "I'm excited by the potential for AI to help medical centers do a better job of finding and recruiting trial participants."
Patient recruitment is widely viewed as cumbersome and expensive. The CCM report cites a 2020 study in the Journal of Medical Internet Research which found that 80% of trials don't meet initial enrollment targets of timelines, with delays resulting in lost revenues of as much as $8 million a day for drug development companies.
Nearly two-thirds (64%) of respondents in the CCM survey say that the most time-consuming, labor-intensive, and frustrating hurdle for launching clinical trials is finding suitable patients, which often requires a manual review of medical records. Using AI to quickly scan medical records to find eligible patients was seen by 61% of respondents as playing a "critical" role.
"AI is seen as having the potential to allow organizations to complete matching, identification, and recruitment tasks at scale, enabling them to participate in more trials," the report says, although noting that "smaller organizations are more likely to be unsure what role AI technology will play."
Marroquin says CCM has "already seen the benefits of using natural language processing to harness and analyze the vast quantities of unstructured data in healthcare to better understand the conditions of our patients."
"Applying these techniques for clinical trial matching would be an advantage for health systems, industry and patients," he says.
The survey found that respondents who don't see AI as playing a critical role in the future "mention that existing analytics capabilities could potentially provide the same outcomes."
However, while some IT vendors offer AI for clinical trials, the survey found that the perception among stakeholders is that the readiness of these systems is "mixed."
One clinical researcher told CCM that "high-fidelity matching benefits greatly from structured data, and a significant amount of needed data is currently in the EHR as unstructured data. This is a significant gap."
The CCM report also identifies disease management and prediction as the top use for AI at health systems. Over the next two years, survey respondents say their AI investments will be aimed primarily around operational optimization.
"Merck's ridiculous lawsuit is the equivalent of a toddler throwing a temper tantrum," says Richard Fiesta, executive director of the Alliance for Retired Americans.
"Americans pay the highest prices in the world for prescription drugs and too many seniors must choose between putting food on the table and paying for their medicine. That is because corporations like Merck have been allowed to charge taxpayers whatever they want for their drugs," Fiesta says.
David Mitchell, a cancer patient and founder of Patients For Affordable Drugs Now, calls the suit "bogus," and ridicules the drug maker's assertion that the negotiation authority granted to the Centers for Medicare & Medicaid Services is "tantamount to extortion."
"The truth is, Big Pharma companies like Merck are the ones who have been extorting patients for years, forcing them to pay unjustified prices or sacrifice their health," Mitchell says.
"The reality is, drug corporations that are subject to Medicare's new authority – and who already negotiate with every other high-income country in the world – will engage in a negotiation process after setting their own launch prices and enjoying nine years or more of monopoly profits."
Sen. Ron Wyden (D-OR), chairman of the Senate Finance Committee, says "it's no surprise that Big Pharma wants to stop Medicare from negotiating lower drug prices on behalf of American seniors."
"I expect the Biden Administration to vigorously defend Medicare's bargaining power so seniors will see the lower drug prices they expect," Wyden says. I have deep concerns that a Republican administration would roll over for Big Pharma and once again ban Medicare from negotiating lower drug prices."
The Medicare Drug Price Negotiation Program was a key provision in the 2022 Inflation Reduction Act. It allows Medicare, for the first time ever, to leverage its unmatched market power to negotiate with drug makers for certain high-price drugs. The negotiations start in September but will be limited to 10 drugs named by Medicare.
Merk's type 2 diabetes drug Januvia has been mentioned as a candidates for the negotiations list.
Merck Alleges 1st, 5th Amendment Breaches
Merck issued a statement this week saying that the suit is justified because the price negotiation program would hamstring the "bio-pharmaceutical sector's ability to address health threats."
"On average, it takes a decade and more than $2.5 billion to develop a new drug. Since 2000, companies like ours have invested more than $1.1 trillion in the search for new treatments and cures, including $102.3 billion in 2021 alone. This investment has led to incredible breakthroughs for patients. Unfortunately, this progress is now at risk due to unconstitutional provisions in the IRA."
"By coercing Merck to provide its drug products at government-set prices, the program takes property for public use without just compensation in violation of the Fifth Amendment. In addition, the IRA creates the false impression that innovators like Merck are voluntary participants in its program by coercing them to sign an "agreement" conveying that the government-set prices are the "fair" result of a "negotiation." That compelled mirroring of the government's political message violates the First Amendment," Merck says.
In addition to its unconstitutionality, Merck says the the IRA will stifle biopharmaceutical research and development.
"Take for example the impact on cancer therapies. Investments by Merck and others in the biopharmaceutical sector have led to important progress in the treatment of earlier-stage cancer, most notably lung cancer. With increased adoption of screening, we have now reached an inflection point at which we are poised to bend the trajectory of the societal burden of cancer. The IRA makes further investment in treatments for earlier-stage cancer and screening far more difficult."
"Because this statute unlawfully impairs our core purpose of engaging in innovative research that saves and improves lives, Merck intends to litigate this matter all the way to the U.S. Supreme Court if necessary. While we do not believe the program is the right approach for continuing to advance global health on behalf of millions of patients in need, Merck remains committed to working with the U.S. government to enable patient-focused innovation, value and access," Merck says.
P4ADNow says Medicare Part D has spent more than $17 billion on the Merck's diabetes drug Januvia, priced at $547 for a month's supply and used by nearly 1 million Medicare beneficiaries. The drug has been on the market since 2006 without competitors since 2017.
"Despite Merck's false claims about innovation, Medicare negotiation will reduce U.S. spending on drugs by only about $25 billion a year in a market projected to be more than $850 billion per year — less than a 3% reduction in spending cannot possibly cripple innovation," P4ADNow says."
Mitchell challenges Merck's claims that the program would stifle innovation.
"The framework laid out by Medicare for negotiation will actually incentivize innovation because the government will pay more for more innovative products by centering the clinical value of a drug in the negotiation process," he says.
The Medicare geriatric primary care network says it will have a footprint in Iowa, Arkansas, Kansas and Virginia by year's end.
CVS Health's newly acquired subsidiary Oak Street Health announced this week that it will open geriatric primary care clinics in four states, which will expand its presence into 25 states by year's end.
"One of the most critical ways we advance our mission to rebuild healthcare as it should be is by bringing our high-quality primary care and unmatched patient experience to more older adults across the country," Oak Street CEO Mike Pykosz says in a media release.
"We look forward to meeting and caring for new deserving patients… as well as the opportunity to create meaningful jobs for those passionate about improving health outcomes for patients and bridging health equity gaps in their communities," Pykosz says.
The expansions are planned for Little Rock, Arkansas; Des Moines and Davenport, Iowa; Kansas City, Kansas and Richmond, Virginia, beginning this summer. Chicago-based Oak Street says it will also continue to expand its existing presence in Arizona, Colorado, Georgia, Illinois, Indiana, Louisiana, New York, Ohio and Pennsylvania this year.
The expansion comes just one month after CVS Health completed its $10.6 billion acquisition of Oak Street and is part of CVS's larger ambition to expand into other profitably areas of care delivery. Woonsockett, RI-based CVS already owns Aetna, pharmacy benefits manager Caremark, and Minute Clinic urgent care centers.
Using a value-based, integrated care model that focuses on wellness and prevention for Medicare enrollees, Oak Street offers primary and behavioral health care through a mix of in-center, in-home and telehealth appointments, as well as a 24⁄7 patient support line.
The provider claims that its emphasis on value-based care has reduced patient hospital admissions by approximately 51% compared to Medicare benchmarks and driven a 42% reduction in 30-day readmission rates and a 51% reduction in emergency department visits.
The AGs had claimed that Invidior used 'product hopping' to block competition from generics for its opioid treatment drug.
Drugmaker Invidior PLC says it will pay $102.5 million to 41 states and the District of Columbia to settle antitrust allegations related to the marketing of its opioid recovery drug Suboxone.
Invidior CEO Mark Crossley says the settlement amount is in line with the original provision of $290 million for the multi-district litigation. Payment is expected to be made this month, with funds coming from the Invidior's existing cash.
"Indivior is focused on helping those who suffer from substance use disorders," Crossley says in a media release. "We take our role as a responsible steward of medications for addiction and rescue extremely seriously. Resolving these legacy matters at the right value allows us to further this mission for patients.”
Indivior got Food and Drug Administration approval for Suboxone in 2002. The prescription drug is used by recovering opioid addicts to reduce or avoid withdrawal symptoms. Along with the FDA approval, Indivior was granted an exclusive seven-years window to sell the drug. In 2010 — a year after Indivior's exclusive right to the Suboxone tablet expired and generics were set to compete — the company switched from tablet to sublingual film, alleging safety concerns.
In response, the AGs sued Indivior in 2016, claiming the company blocked competition by with a scheme known as “product-hopping”, where drugmakers retain a monopoly on profitable drugs by slightly reformulating them to block generics without delivering new therapeutic benefits for patients.
California Attorney General Rob Bonta, whose state will get $7.1 million from the settlement, says high drug costs are a big problem for Californians, “and Indivior contributed to that problem by preventing lower cost generics from competing with Suboxone.
"Opioid addiction treatments should be accessible to everyone — especially our most vulnerable populations that need them for their recovery,” Bonta says. “With today's settlement, we're holding Indivior accountable and ensuring it doesn't engage in similar anticompetitive conduct in the future."
In addition to requiring Indivior to pay $102.5 million:
Indivior must provide the states with information and reasons for any reformulated versions of Suboxone;
Indivior must leave the Suboxone on the market for a limited period if generic alternatives are brought out, thus allowing doctors and patients to choose which formulation they like better;
If Indivior files an FDA Citizen Petition to delay generic competition, it must also submit any data or information underlying that petition to the FDA and the states.
The Missouri-based health systems hope to complete the deal by the end of the year.
BJC HealthCare of St. Louis and Saint Luke's Health System of Kansas City say they're exploring a merger that would create the largest health system in Missouri, serving "two distinct geographic markets."
The boards of directors at the systems this week unanimously approved a non-binding letter of intent to form an integrated, academic health system that they claim will expand "healthcare access to high-quality patient care for more than six million residents in Missouri and beyond."
The systems hope to finalize the merger by the end of 2023, assuming regulatory approval.
The systems are based in Missouri's two biggest cities, with headquarters located about 250 miles apart. The 28 hospitals and scores of clinical venues created by the consolidated system, if approved by state and federal regulators, would serve "two distinct geographic markets," the systems say.
It is not clear how a consolidated healthcare system would affect consumer costs, but numerous studies have shown that healthcare consolidation -- including hospitals, physician practices, drug makers, and payers – usually lead to higher prices for consumers.
If the merger is consummated, the systems will continue to serve their "two distinct markets," maintain their existing brands, and operate from dual headquarters in St. Louis and Kansas City
The merged system's C-suite and board of directors will include representation from both BJC and Saint Luke's. BJC President and CEO Richard Liekweg will be CEO of the consolidated system, with the inaugural board chair coming from Saint Luke's.
Liekweg says the hoped-for merger addresses challenges created by "the rapidly changing healthcare landscape."
"With an even stronger financial foundation, we will further invest in our teams, advance the use of technologies and data to support our providers and caregivers, and improve the health of our communities. These are opportunities that we can better achieve together," Liekweg says.
Saint Luke's President and CEO Melinda Estes, MD, says the two systems enjoy "well-established reputations for delivering exceptional care and elevating the health of the people we serve."
"Through our decade-long relationship as a member of the BJC Collaborative, we've established mutual trust and respect, so the opportunity to come together as a single integrated system that can accelerate innovation to better serve patients is a logical next step," she says.
BJC is one of the nation's largest nonprofit health systems with 14 hospitals, including Barnes-Jewish and St. Louis Children's Hospital, an affiliation with Washington University School of Medicine, and dozens of care venues serving greater St. Louis, southern Illinois and southeast Missouri.
The 140-year-old, faith-based Saint Luke's Health System includes 14 hospitals and campuses and more than 100 primary care and specialty offices, treating patients in 67 counties in Missouri and Kansas.
Northwell specialists will also provide support for DOS pre-deployment medical clearances and clinical case reviews.
Northwell Direct has been picked as the subcontractor to provide 24/7/365 telehealth consulting services for clinicians who provide care for U.S. State Department of State workers and their families posted overseas.
"Telemedicine is a unique area of opportunity for Northwell Direct to provide support and expertise to the Department of State," says Jonathan Berkowitz, MD, medical director of center emergency medical services at Northwell Health.
"We are virtually leveraging the collective expertise of our health system in innovative ways," Berkowitz says. "The breadth and depth of services we have across our network, coupled with our advanced telehealth and integrated technology platform, allows us to extend our reach and impact far beyond the traditional borders of the health system and appropriately support the Department of State."
The DOS has about 13,000 foreign service employees, 11,000 civil service employees, and 45,000 locally employed staff at more than 270 posts worldwide.
Northwell specialists will also provide support for DOS pre-deployment medical clearances and clinical case reviews. More than 100 specialties across medical, surgical, psychiatry and pediatrics will be made available to DOS providers, with the most consulted specialties including orthopedics, cardiology, radiology, neurosciences, dermatology, and emergency medicine.
"Northwell Direct is proud to be working with the United States Department of State and doing our part to ensure that the employees and family members who serve our country have access to the highest quality healthcare services while serving abroad," says Northwell Direct CEO Nick Stefanizzi. "The broad range of services we have deployed to meet the unique needs of the DOS are representative of the wholistic approach Northwell Direct takes to support all of its employer clients both domestically and internationally."
The bill would permanently expand telehealth services that were adopted during the coronavirus pandemic.
A bipartisan coalition in the U.S. House has filed legislation to make permanent the coverage for telehealth services under Medicare that was expanded during the recently ended Public Health Emergency.
The bill, Protecting Rural Telehealth Access Act is cosponsored by U.S. Rep. Chris Pappas (D-NH) and Republican Representatives Lisa McClain of Michigan, Jake LaTurner of Kansas, Marcus Molinaro of New York, Alex Mooney of West Virginia, and Zach Nunn of Iowa. A companion bill was filed the U.S. Senate by Jeanne Shaheen (D-NH) in 2021.
If enacted, the bill would permanently expand telehealth services that were adopted during the coronavirus pandemic, including continuing to allow rural health clinics and Federally Qualified Health Centers to provide telehealth services, and expanding coverage of audio-only services for certain conditions.
"Access to quality healthcare should not be a luxury reserved for urban areas. Rural communities matter and deserve the same level of care and convenience," Molinaro says. "This bipartisan legislation makes permanent telehealth flexibilities that were originally implemented during the COVID-19 pandemic. In doing so, we will ensure Upstate New Yorkers have access to the care they need, regardless of their zip code."
Pappas says the expansion of telehealth under the PHE has greatly benefited his constituents, particularly those who live in rural areas.
"Being able to access care virtually has ensured more people can receive the right care at the right time while saving them both time and money by eliminating transportation costs,"Pappas says. "Making coverage of telehealth services permanent is a practical proposal that benefits patients and providers alike."
A 2022 policy paper by the National Rural Health Association notes that 77% of rural counties in the United States have a shortage of primary care clinicians, which adversely affects about 60 million people. The statistics are even worse for specialists.
"It is imperative that Congress permanently extend the telehealth flexibilities enacted at the beginning of the COVID-19 public health emergency," NRHA says in the paper. "Coupling the continuation of flexibilities with investments in rural broadband is crucial to expanding access to care for rural patients."
The NRHA has also called on the Centers for Medicare and Medicaid Services to evaluate clinical care outcomes for telehealth visits compared to in-person visits, and to allow flexibility and standardization within telehealth to ensure consistency post-PHE.
In addition to the National Rural Health Associate, the bill is supported by more than 20 stakeholder organizations, including the Alliance for Connected Care, the American Academy of Family Physicians, the American Academy of Allergy, Asthma, and Immunology, the American College of Allergy, Asthma, and Immunology, America’s Essential Hospitals, the American Medical Group Association, the American Telemedicine Association, and the Medical Group Management Association.
GI docs say the payer is using AI to move large volumes of services through prior authorization.
Effective June 1, UnitedHealthcare will require prior authorization for nearly half (47%) of gastrointestinal (GI) endoscopies. The payer says the move is needed to curb costs related to alleged overuse of some GI procedures by physicians.
Physicians counter that the move is the latest evidence that UHC is tapping artificial intelligence to move large volume services through prior authorization.
The news does not sit well with GI docs, who believe that the prior authorization process is often abused by payers to create a hurdle for patients and providers to clear when filing claims and getting paid.
HL: Has UHC explained to you why it is imposing this new PA mandate?
Hennessy: UHC says geographic variation exists in the use of endoscopy services but refuses to share any further information about that variation. For example, we have asked whether the variation is confined to certain regions or certain codes within certain geographic areas. With more information, ASGE can engage in education and outreach to ensure that gastroenterologists are familiar with endoscopy guidelines and encourage them to participate in quality improvement activities.
Many of the CPT codes covered by the GI endoscopy prior authorization program are low volume and, therefore, could not be considered over-utilized. On several occasions, the GI societies have asked UHC to share its own de-identified, aggregate data that show recent evidence of over-utilization. Our requests have been denied. UHC instead has referred to studies they claim suggest over-utilization in GI endoscopy. To date, we have received no information from UHC that substantiates over-utilization for any GI endoscopic or capsule endoscopy procedure.
What GI and other specialties are experiencing is payers using artificial intelligence (AI) to move large volumes of services through prior authorization. With the help of AI, payers have little-to-no economic downside to increase the number of services, including low-cost services, that are subject to prior authorization. If payers are going to increase the burden of prior authorization on physicians and other providers, they should be required to be transparent about the need for prior authorization and the method of review on a service-by-service basis.
HL: Why do you object to this PA requirement?
Hennessy: Physicians are overwhelmed with prior authorization requirements. The process of prior authorization is not transparent and denials and appeals for medically necessary services oftentimes result in patient harm. Further, UHC has not been transparent with evidence of over-utilization or geographic variation for the endoscopy services for which prior authorization will be required beginning June 1.
ASGE is on record supporting "Gold Card" programs which exempt physicians and other health care providers from a payer's prior authorization requirements if they meet certain eligibility requirements. For example, when a physician has high rates of prior authorization approvals for a particular service, including when that service is initially denied and approved on appeal.
In a March 9, 2023 news release, UHC promised to ease prior authorizations and announced that in early 2024 it would implement a national Gold Card program for certain provider groups, "eliminating prior authorization requirements for most procedures."
When ASGE asked UHC why it would not delay a new prior authorization program for GI endoscopy services and instead wait to utilize a Gold Card program to mitigate provider administrative burden, UHC representatives said the exact timing for the Gold Card program is unknown and that the Gold Card program and prior authorization for GI services are on "different trajectories."
UHC's decision to require prior authorization for nearly 50% of all endoscopy codes makes their public promise to reduce prior authorization burden on physician practices appear disingenuous at best.
HL:What specific patient health fallout would be expected with these new PA requirements?
Hennessy: The experience of ASGE members is that prior authorization delays patient access to recommended services. The expectation is patients who do not have a confirmed diagnosis of a GI disease or disorder but visit a gastroenterologist because they are experiencing abnormal signs or symptoms will suffer the most because physicians expect they will have to work harder to justify to UHC why the patient should receive an endoscopic procedure. Sometimes patient symptoms do not fit in an algorithm or may be limited in nature. Patients with limited English language proficiency might have difficulty articulating their symptoms. In these types of situations, a physician must interpret the symptoms and make the most appropriate recommendations regarding testing and treatment options. Those are the types of cases that are most likely to get spit out of an AI algorithm with a denial because the service requested does not match a diagnosis code.
Clinics that serve underserved areas may not have staffing to meet the demands of a new prior authorization program. At the same time UHC is implementing this program, which lacks any clear benefit to patients and that will require increased physician practice staffing, our health care system is experiencing a staffing crisis.
HL: Is there an average per patient cost/charge for endoscopies requiring PA, vs. endoscopies NOT requiring PA?
Hennessy: There is not a difference in the cost or charge to the patient for endoscopies requiring prior authorization versus those that do not. The physician practice incurs the staff cost associated with obtaining prior authorization — a cost that does not get passed onto the patient.
Insurance companies have no "skin in the game," especially with the use of AI when it comes to requiring prior authorization. We would like to see the tables turned and require payers to compensate physician practices for the cost associated with prior authorization when a service is initially denied and eventually approved on appeal.
Patients are increasingly encountering roadblocks to accessing recommended or prescribed care due to prior authorization and other utilization management tools that insurance companies claim are necessary to lower the cost of health care; yet, insurance premiums keep rising.
HL: What are the specifics of the "47%" of GI endoscopies requiring PA?
Hennessy: UHC is placing 61 endoscopy codes under prior authorization. These 61 codes represent roughly 47% of all endoscopy codes.
HL:How are they different from the (presumably) 53% of endoscopies that do NOT require PA?
Hennessy: The codes that will be subject to prior authorization are codes typically provided in the outpatient/ambulatory setting. The UHC prior authorization requirements are not applicable to services provided in the emergency room, urgent care centers, hospital observation units and the hospital inpatient setting.
The other 53% of codes include, but are not limited to advanced endoscopy procedures, such as ERCP and EUS, colorectal cancer screening, and capsule endoscopies codes.
HL:What action, if any, can your association take to oppose these PA requirements?
Hennessy: The ASGE has been working alongside the American College of Gastroenterology and the American Gastroenterological Association to oppose implementation of UHC's prior authorization program for endoscopy services on June 1. We have met with UHC and have presented them with a number of operational questions and have requested data that justifies this sweeping program. The request for data has been denied and many operational questions and concerns remain unanswered.
Earlier this month, ASGE and 171 other patient and provider organizations sent a letter to UHC asking the company to not implement the GI endoscopy prior authorization program, stating that it will limit access to care for vulnerable populations, delay diagnosis of colorectal cancer in younger populations, and needlessly increase physician and practice burden. There has been no response to the letter to date.
ASGE and the other GI societies are also meeting with congressional offices, and we are pleased the House Energy and Commerce Committee and the Senate Permanent Subcommittee on Investigations have launched inquiries into the use of AI for prior authorization by the nation's largest payers.
HL: What are you recommending your association members do in response to this new PA mandate?
Hennessy: ASGE and the other GI societies have asked their members to contact their state lawmakers with a request that they encourage state regulators to look into UHC's decision to move forward with the prior authorization program for endoscopy services with just 90 days advance notice and no transparency of data that support the implementation of such a sweeping program.
UHC Responds
HealthLeaders reached out to UnitedHealthcare about the new PA requirements, and received this response:
"We have made no changes to our policy regarding screening colonoscopies for preventive care, and this policy does not impact screening colonoscopies. We are asking physicians to follow the guidelines and evidence-based practices developed by their own gastroenterology medical societies to help ensure our members have timely access to safe and clinically appropriate care. The physicians who will be most affected by this new policy are those who are not already following these evidence-based practices, which again, were developed by gastroenterology-related medical societies."
"Our electronic submission process allows for immediate approvals for physicians who have a history of following evidence-based guidelines for the requested procedure. For procedures that do not receive immediate approval, decisions are typically made within two business days after receipt of all required clinical information needed for our GI specialists to review the case – well within the average wait time to schedule a service included in this policy."
However, the poll responses skew against older adults with annual household incomes below $60,000, Blacks or Hispanics, all of whom generally have lower rates of portal use, and are less likely to say they're comfortable using a portal, than respondents who are higher-income or non-Hispanic White.
Variations also were reported among older adults who say they're in fair or poor health physically or mentally are more likely to say they're not confident about their ability to log in and navigate a portal.
Even among older adults who use portals, the poll shows many prefer phone calls for scheduling or medical questions. However, portal users in general say they prefer the portal to the phone when getting test results and requesting drug refills.
The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine.
The jump in portal use between polls done in 2018 and 2023 coincides with the rise of telehealth visits during the COVID-10 pandemic, says Denise Anthony, Ph.D., the U-M School of Public Health researcher, which prompted providers to supplement video visits within their secure websites and apps.
"This change makes access to secure portals even more important for older adults who want to see their doctors and other healthcare providers virtually. It also makes the disparities we found in our poll even more troubling," says Anthony, chair the Department of Health Management and Policy.
"Improving the functionality and accessibility of portal systems, as well as providing more outreach and training to help patients understand and use portal systems, will be crucial to improving equity," Anthony says.
Many portals allow patients who have created their own accounts to also grant a loved one access to some or all of their information, so they can help manage their healthcare. The new poll shows
The polls shows that nearly half (49%) of portal have granted access to their portal accounts to a spouse, partner or relative , users have done so, up from 43% in 2018, with 48% of men doing so compared with 32% of women.
Poll director Jeffrey Kullgren, MD, MPH, MS, an associate professor of internal medicine at Michigan Medicine, says that a "growing body of evidence shows that patients who use portals to access their information are more likely to take an active role in their care and stick to the treatment plan their physicians and other providers recommend, which we know is likely to lead to better outcomes."
Kullgren says 27% of the poll respondents who've used a portal in the last year say they want more training. The percentage was higher among older adults who haven't used a portal recently, and those who are Black, Hispanic or have incomes below $60,000.
Kullgren says providers should make an effort to engage and support patients who have not accessed a portal, and to offer training to bolster confidence and encourage sharing access with trusted loved ones.
"This is especially important for patients who have complex health needs or multiple conditions," he says.
Indira Venkat, senior vice president of research at AARP says the increased use of virtual care by older adults is encouraging, but that more needs to be done.
"Research shows that while more older Americans are embracing technology, nearly 22 million older adults still do not have wireline broadband access at home, limiting their access to essential digital healthcare services like patient portals," Venkat says. "Closing the digital divide among older adults is critical to improving their wellbeing, especially for vulnerable communities and individuals."
The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in January 2023 among 2,563 adults aged 50 to 80.
The policy change is expected to significantly raise the wage index in several states.
The Centers for Medicare and Medicaid Services is proposing a policy change for the rural floor wage index in 2024 that could have profound financial effects on urban and rural hospitals across the nation, one expert says.
Under the proposal CMS would treat hospitals with rural classifications the same as geographically rural hospitals when calculating the wage index. The policy change is expected to significantly raise the wage index in several states, according to Health Law News.
While that in itself is not necessarily problematic, the Social Security Act mandates the "Rural Floor Budget Neutrality Adjustment", which prohibits increases in overall Medicare payments.
Milwaukee-based healthcare regulatory expert Joe Krause, an attorney with Hall, Render, Killian, Heath & Lyman, P.C., took time this week to answer some questions about the proposed change in the policy, and how it will affect providers.
What does the proposed rule do?
For the Medicare Program, the wage index applicable for any hospital located in an urban area of a state may not be less than the wage index applicable to hospitals located in rural areas. This is known as the "rural floor.”
In the Proposed Rule, CMS is proposing to change its policy for the rural floor to treat hospitals with rural reclassification (also known as §401 or §412.103 rural reclassification), the same as geographically rural hospitals for purposes of calculating the wage index. Specifically, CMS would include hospitals with §412.103 rural reclassifications and geographically rural hospitals in rural wage index calculations beginning with FY 2024. By doing this, CMS has significantly increased the rural wage index factor for several states, which would also increase the wage index for lower urban areas of the state.
When does it take effect?
The rule would impact the calculation of the wage index starting with inpatient payments on 10/1/23 and outpatient payments on 1/1/24.
What chance does it have to be adopted?
That is hard to say. Ordinarily, a change this big would get finalized unless there is a good basis (legal or otherwise) for CMS to change its decision.
Do you believe it will see significant changes after the public comment period?
No, I think the proposed rule will either be adopted or not adopted, in which case CMS would keep the existing rule in place. I don’t foresee an in-between.
How does it differ from the existing rule.
Currently, CMS only includes the impact of rural reclassified hospitals in the rural floor calculation if the hospital stays in the rural location. For various reasons, most hospitals that obtain rural reclassification subsequently reclassify out of the rural wage index area to an urban area and are not currently included in the rural floor calculation.
Why does CMS think this proposed rule is was necessary?
CMS commentary for this proposed change went through the rural floor policy and recent court decisions that address how CMS treats rural reclassified hospitals for different purposes. Based on that discussion, CMS proposed to reinterpret the rural floor calculation and how they treat rural reclassified hospitals under that calculation.
How will this proposed rule affect providers?
As stated above, this proposed change will significantly increase the rural wage index in many states, which would also increase the wage index for certain urban areas of the state. The Medicare Hospital Inpatient Prospective Payment System ("IPPS”) and Outpatient Prospective Payment System ("OPPS”) adjust a standardized amount for differences in hospital wage levels, which CMS implemented through the wage index system. If hospitals see their wage index go up by this policy, that would lead to increased Medicare payments.
However, the Social Security Act requires that the rural floor policy be budget neutral. Increases in wage index from this policy change cannot increase overall Medicare payments. CMS maintains budget neutrality of the rural floor through an adjustment known as the "Rural Floor Budget Neutrality Adjustment,” which is applied to the wage index of all hospitals. Some hospitals would see an increase in wage index and Medicare payments due to this policy change, while others would see a decrease because of the budget neutrality adjustment. But overall, Medicare payments will remain the same. This changes how the pie is divided up.
What should hospitals do to accommodate or oppose this new rule?
Hospitals should consider submitting comments to CMS as to whether they support or oppose this change and those comments are due by June 9th. Hospitals should also let their hospital association know if they support or oppose it.
