Patients say they'll tolerate the technical glitches in exchange for engaged screen time with providers.
Low-income Californians generally expressed comfort and satisfaction with their telehealth experiences, but also want the option of accessing in-person care, a new survey shows.
The survey, conducted by NORC at the University of Chicago and commissioned by the California Healthcare Foundation, found that many of the 73 low-income Californians interviewed in the second half of 2022 acknowledged certain "trade-offs" that come with using remote care, such as the occasional audio and video connectivity issues, while at the same time reporting that their providers are more engaged in their care in video visits, which helps them to build trust with their providers and in telehealth.
"Ultimately, many participants who experience both phone and video visits see the value of each visit modality in different situations," the report says.
The survey subjects also told NORC that:
* Telehealth removes barriers to care, such as financial and transportation costs, that can hamstring access to in-person care. "Interviewees appreciate the ease of access and convenience of telehealth visits, especially interviewees with disabilities, those with mental health conditions, and those who identify as transgender or nonbinary," the report says.
* Telehealth helps patients build stronger relationships with providers. "Overwhelmingly, participants report high levels of satisfaction and trust with the care that they receive via phone or video," the report says. "Moreover, many feel that their relationships with providers are strengthened through more frequent and easier contact."
* Telehealth visits with providers proficient in the patients’ language results in high-quality care. "Participants who prefer to receive care in a non-English language who receive such visits report high levels of satisfaction and confidence in their communications with their providers," the report says. "As with other patients, telehealth visits help these participants build trust and strengthen their relationships with providers."
* They want telehealth to play a central role in their future care, with most interviewees saying they would like to receive at least half of their care via telehealth.
* They want to be involved in decisions about the modality of their visits and choosing which type of visit (i.e., phone, video, or in-person) makes sense for their specific health concern. Most of these patients like the idea of partnering with their provider in making this choice.
Leadership at Louisiana's largest health system cites clinical workforce shortages and COVID-related financial strains.
Ochsner Health will eliminate 770 mostly management and nonclinical positions in Louisiana and Mississippi to address workforce shortages and financial stressors, CEO Pete November says Thursday in a memo to employees.
"Healthcare providers across the country have experienced increased labor costs, a shortage of patient care clinicians, high inflation and the end of pandemic relief funding from the government," November says in his memo. "Despite progress and our significant efforts to reduce expenses, we need to do more to ensure we can continue to deliver on our mission and meet the needs of the patients and communities we serve."
"Today, we are taking the difficult step of reducing the size of our workforce by eliminating 770 positions, which represents roughly 2% of our team. Impacted positions are management and primarily non-direct patient care roles."
November pledged in an interview with NOLA.com that the layoffs would be the first and the last contemplated by Ochsner. "We want everyone to know that when we are finished with this round we are done. This is it," November tells the website. "Folks do not have to come to work every day worried about what comes next."
NOLA.com reports that Ochsner's revenues were $6.4 billion in 2022, up from $5.9 billion in 2021. However, the New Orleans-based system lost $96 million last year and its expenses exceeded revenues by 1.5%. It's not clear how many of the eliminated positions are vacant, but the cuts are projected to save up to $150 million annually.
Ochsner operates 47 hospitals and more than 370 care venues in Louisiana, Mississippi, Alabama and the Gulf South. The system employs more than 36,000 people and more than 4,600 employed and affiliated physicians.
For laid-off employees, November pledged to "do everything we can to deliver the resources and support our team needs and treat everyone leaving our organization with the respect and dignity they deserve," including providing up to 65 days of full pay and benefits and other severance packages, career and job-hunting support, and details for applying for other jobs at the health system.
"For those talented professionals who will be leaving us today: this is not the experience we hoped you would have at Ochsner. I want to thank you for all you have done and for sharing your talents with us," November says.
Jaewon Ryu, MD, will transition to become the first CEO of the value-based KP affiliate when the deal is finalized.
The top executive at Geisinger Health says his Danville, PA-based system's planned affiliation with Kaiser Permanente's newly created Risant Health division will bolster and "accelerate" the nation's transition to value-based care.
In this interview with HealthLeaders, Geisinger President and CEO Jaewon Ryu, MD, JD, discusses the goals and community health benefits of Risant, where he will serve as inaugural CEO, transitioning from Geisinger when the deal closes.
HealthLeaders: Why is Risant Health needed?
Ryu: Nonprofit, community-based health systems play a pivotal role in the health of their communities and especially for those that aspire to accelerate on their "value-based care" journey, there's an opportunity to have an even larger impact.
But value-based care doesn't happen easily or quickly. It requires investments and capabilities to redesign the care model to deliver more services upstream as an alternative to delivering that care in downstream environments like the hospital and the ER.
By building a platform that can house these capabilities, these like-minded and mission-oriented systems can access the right expertise, tools for patients or members or providers, state-of-the-art technologies, sophisticated data and analytic insights, etc., all enabled through a more digital channel.
For us at Geisinger, this is a way we can accelerate our mission – to make better health easier for the communities we serve. We realized that when it comes to value-based care, there is no one better in the industry than Kaiser Permanente – a best-in-class organization spanning health plan and care delivery operations across 8 states and the District of Columbia.
Being part of Risant Health will allow us to access the tools, expertise, and capital required to accelerate our charitable mission and strategy and expand our impact to our communities across Pennsylvania and beyond.
HL: What do you hope to achieve regionally, nationally?
R: Kaiser Permanente has stated Risant Health's vision is to improve the health of people and communities by increasing access to value-based care and coverage. For mission-aligned organizations that are committed to advancing care models that aim to address people's care needs as upstream as possible, in as easy a way as possible, Kaiser views Risant Health as a way to fuel and accelerate their efforts with the right capabilities.
HL: How will you measure success?
R: Through Risant Health, Kaiser Permanente has shared its desire to seek out like-minded entities that are committed to quality care and improving access and affordability by promoting value-based care models in different geographic areas.
Kaiser will evaluate its success through better measures of health in the population, for example things like lower blood sugars in diabetic patients or fewer ER or hospital visits for those with congestive heart failure or detecting cancers earlier through more effective preventive screening rates.
R: We look forward to addressing all questions that the regulating agencies may pose as they review the transaction and are hopeful for a positive response. As we have shared, we believe that the transaction with Risant Health will enhance competition and provide beneficial options to consumers by improving access and affordability of healthcare services to more people in more communities.
HL: Can you assure Geisinger patients and the community that this deal will not result in higher healthcare costs?
R: Following closing, patients will continue to access care as they do today. Geisinger will continue to accept non-Geisinger health coverage for its care, operate its health plan, partner with non-Geisinger provider organizations, and work with non-employed physicians, just as it does today. And Geisinger's 600,000 health plan members will continue to receive coverage from Geisinger as they do today.
Longer term, we believe Risant Health's efforts to advance value-based care will result in Geisinger members and patients experiencing enhanced quality and experience, as well as more affordable care, all at a better trajectory than would be otherwise.
Documentation errors and omissions for tele-mental health services accounted for $348 million.
More than half of the $1 billion in temporary pandemic-related psychotherapy services paid by Medicare in the first year of the public health emergency were incorrectly billed, federal auditors say.
The Department of Health and Human Services Office of the Inspector General examined the Centers for Medicare & Medicaid Services' mental health services records for both in-person and telehealth visits from March 2020 through February 2021 at the start of the public health emergency.
The audit covered approximately $1 billion in Part B payments for more than 13.5 million psychotherapy services during the period. The audit picked two random samples of psychotherapy services: one of 111 enrollee days for telehealth services, and the other of 105 enrollee days for in-person services.
For 128 of the sampled 216 enrollee days, providers did not properly document psychotherapy time or omitted other needed information. In 54 sampled enrollee days, providers' failed to sign their claims.
"Based on our sample results, we estimated that of the $1 billion that Medicare paid for psychotherapy services, providers received $580 million in improper payments for services that did not comply with Medicare requirements, consisting of $348 million for telehealth services and $232 million for non-telehealth services," OIG says.
"The deficiencies we identified in our audit occurred because CMS's oversight was not adequate to prevent or detect payments for psychotherapy services, including telehealth services, that did not meet Medicare requirements and guidance," OIG says. "CMS's oversight was partially affected by the unprecedented challenges of the PHE because CMS's focus was to ensure that Medicare enrollees had access to health care."
"However, as CMS continues to reinstitute its program integrity measures and considers making other permanent changes to telehealth services, CMS should focus on implementing adequate oversight of providers to minimize the risk of paying for psychotherapy services, including those provided via telehealth, that do not meet Medicare requirements."
The health system denies intentionally filing false billings, and has worked with regualtors to resolve the case.
Northwest Arkansas Hospitals, LLC will pay $1.1 million to settle allegations that the not-for-profit health system improperly billed the state's Medicaid program on 246 occasions, Arkansas' U.S. Attorney Tim Griffin says.
Griffin says in a media release that the violations of the Arkansas False Claims Act were found during an audit by the Arkansas Foundation for Medical Care, which showed that records submitted by Northwest Hospitals for its claims "did not justify or support the medically necessary requirement for hospitalizations."
In a statement to the media, Northwest spokeswoman Christina Bull says the submissions to Medicaid "were based on medical evaluations, diagnoses and other supporting documentation created by the unit's former independent medical director Dr. Brian Hyatt and non-physician providers working under his supervision and direction in the unit."
"While there is no evidence that the hospital intended to submit improper claims, we also believe settlement is in the best interest of the organization at this time," Bull says.
Griffin notes that "Northwest has cooperated at all points during this investigation."
"While state and federal law give great deference to the diagnosis made by a medical doctor, all Medicaid providers must maintain complete and accurate records that justify claims filed and fully document the medical necessity of all services," Griffin says.
The bureau warns that a burgeoning medical credit card market could exacerbate medical debt woes for millions of people.
Americans put about $23 billion in healthcare expenses from 2018 to 2020 on high-interest medical credit cards and medical installment loans and paid about $1 billion in interest and other fees, a federal watchdog says.
And the Consumer Financial Protection Bureau in a new report, warns that the proliferation of these payment schemes "can create a significant financial burden for patients and deter them from seeking needed healthcare in the future."
The cards were used more than 17 million times in the three-year span to pay for everything from medications and lab work to emergency department visits for bills ranging from $35 to $40,000, the report says, warning that the proliferation in the marketing and use of medical credit cards, medical installment loans and other "high-cost specialty products" can easily and quickly saddle consumers with mountains of debt.
Medical financing companies market their credit cards and payment schemes directly to hospitals and other care venues, and patients are often offered these credit cards in physicians’ offices, the report notes, "even when their insurance may cover the procedure, or they qualify for a hospital’s reduced or no-cost financial assistance program."
"Fintechs and other lending outfits are designing costly loan products to peddle to patients looking to make ends meet on their medical bills," CFPB Director Rohit Chopra says. "These new forms of medical debt can create financial ruin for individuals who get sick."
The report warns that financial terms and interest rates of many of the medical credit cards and medical installment loans are also "significantly higher than traditional consumer credit cards, 26.99% to 16%, respectively," and that the payment plans "often have deferred interest plans, with all accrued interest potentially becoming due at the end of a defined period, which can prove especially expensive and unaffordable for patients."
To bolster the use of medical credit cards, the CFPB says financial firms woo providers with a promise of quick payments, minimal financial risk and administrative ease. The report warns that after accepting these incentives, providers may be "disincentivized to explain legally mandated financial assistance programs or zero-interest repayment options before offering these products to patients."
The report also found that credit cards, installment loans and other deferred-interest payment plans are often sold to patients with little disclosure or explanation of the terms of the debt. Clinicians pushing the products on their patients often rely "solely on marketing materials and training that financing companies provide to them at no cost," the report says.
Worse still for consumers, financing medical debt on a credit card could increase patients’ risk of legal exposure if they’re in arears because creditors could use aggressive collecting tactics such as lawsuits that providers typically wouldn’t pursue.
The award dates to 2017 and 2018, when Envision and UnitedHealthcare had an in-network agreement.
An independent arbitration panel has ruled that for-profit physician services provider Envision Healthcare is owed $91.2 million in its long-running fight with UnitedHealthcare over disputed payments.
UnitedHealthcare could pay even more, because the three-member panel from the American Arbitration Association may also consider additional payments to cover prejudgment interest and Nashville-based Envision's attorney's fees, court costs, and other expenses related to the dispute, which dates back to 2017.
Jim Rechtin, CEO of private equity owned Envision, says the physician services provider is "very pleased with the outcome," but complained that "it should not take five years to get paid for the lifesaving care our clinicians provide."
"We currently have three other lawsuits against UnitedHealthcare, which will likely take several more years to resolve. It is challenging to create a stable environment for our teams when health plans choose not to pay their bills," Rechtin says.
The award dates to 2017 and 2018, when Envision and UnitedHealthcare had an in-network agreement. Envision complained that UnitedHealthcare breached the terms of that contract when it unilaterally cut payments for services Envision rendered as an in-network provider.
In a statement emailed to HealthLeaders, UnitedHealthcare noted that the settlement is unrelated to its other lawsuits with Envision.
A spokesman with the Minnesota-based payer says they "disagree with the panel's decision."
"However, it did reject many of Envision's claims, including damages it was seeking," the spokesman says. "We remain committed to helping contain rapidly rising healthcare costs for the people and employer customers we're privileged to serve. We'll continue efforts to protect our members and customers from the small number of bad actors—often private equity-backed physician staffing companies like Envision—who demand unreasonable and anticompetitive rates for their services and drive up the cost of care for everyone."
Rechtin says the decision "sets a critical precedent for insurers like UnitedHealthcare to pay in full for the high-quality care its members receive in their most acute time of need."
"While we are disappointed that we had to take the step of entering into arbitration to compel UnitedHealthcare to pay its bills, we are satisfied with the panel's decision against UnitedHealthcare and its systematic underpayment to clinicians for the care they provide," he says.
Peach State clinicians who violate it risk censure from their respective professional credentialing boards.
Effective July 1, any clinician in Georgia who claims to be a medical specialist better have the credentials to back it up, under a new law signed this week by Gov. Brian P. Kemp.
Under Georgia Senate Bill 197, also known as the "Health Care Practitioners Truth and Transparency Act," a clinician's advertisements must include the clinician's names, and the specific license that the clinician holds for specific services.
The law also bans the use of the title "doctor" by nonphysicians in clinical venues. Advanced practice nurses and physician assistants with doctorates who identify themselves as "doctors" must make it clear in their advertising that they are not a medical doctor or a physician.
Georgia clinicians who violate the new law risk disciplinary action from their respective professional credentialing boards.
Michael W. Champeau, MD, FAAP, FASA, president of the American Society of Anesthesiologists, strongly supports the new law, which he says "makes it clearer for patients to make informed decisions because they know the qualifications of the professional providing their care."
"Every patient deserves to be certain of exactly who is performing and responsible for their care during a procedure or surgery," Champeau says.
Joon Sup Lee, MD, replaces interim CEO Dane C. Peterson, who has served in that role since September 2022.
Cardiologist Joon Sup Lee, MD, president of physician services at UPMC, has been named CEO of Emory Healthcare, effective July 1, the Atlanta-based academic health system announced this week.
"I am honored to have the opportunity to join such a strong leadership team and to be a part of a truly world-class academic medical center," Lee says in a media release. "The outstanding faculty and staff at Emory Healthcare are second to none, and will fulfill our mission to deliver the highest quality care with the utmost compassion while training the health care workforce of tomorrow and creating innovations in health sciences that will set the new paradigm for health care."
Lee replaces interim CEO Dane C. Peterson, the president and COO of Emory Healthcare, who has served in that role since September 2022. The 11-hospital system includes 250 care venues and more than 24,000 employees in the Atlanta area.
As president of UPMC Physician Services, Lee oversees 5,000 employed physicians and all clinically active faculty, with a focus on quality of care, patient experience, patient access and financial oversight of physician services. During Lee's 25-year tenure, he has played a role in UPMC's growth from a five-campus hospital system to a more than 40-hospital mega-system.
"I am thrilled that Dr. Lee will take on this important leadership role at Emory Healthcare," says Emory University President Gregory L. Fenves. "He is a problem-solver who cares deeply about the patients and families he serves and the doctors, nurses and health care staff he works with."
An interventional cardiologist, Lee's research has focused on the use of stem cells for treating coronary artery disease, rapid treatment of cardiac emergencies and catheter-based therapy for valvular heart disease.
Lee received his bachelor's degree from Dartmouth College and his medical degree from Duke University's School of Medicine. He completed a medical internship and residency, as well as two cardiology fellowships in cardiology and interventional cardiology, at Massachusetts General Hospital in Boston.
He joined the University of Pittsburgh faculty in 1996 where he has served in leadership roles, including chief of cardiology at the University of Pittsburgh School of Medicine and CMO for the UPMC Health Plan. Lee is certified in cardiovascular disease by the American Board of Internal Medicine. He is a fellow in the American College of Cardiology and Society for Coronary Angiography and Interventions.
Auditors blame CMS for failing to establish a data-sharing agreement with the VA.
Medicare overpaid providers about $128 million over five years for medical care that the Veterans Administration had already paid for, federal watchdogs report.
The Department of Health and Human Services Office of the Inspector General determined that the "duplicate payments occurred because the Centers for Medicare & Medicaid Services did not implement controls to address duplicate payments for services provided to individuals with Medicare and VHA benefits."
"Specifically, CMS did not establish a data-sharing agreement with VHA for the ongoing sharing of data between the two agencies and did not develop an interagency process to include VHA enrollment, claims, and payment data in CMS's data repository," OIG says. "Inclusion of these data, which is required by federal law, would have allowed CMS to compare VHA claims data with existing Medicare claims data to identify duplicate claims paid for by both Medicare and VHA."
The audit covered $19.2 billion in Medicare Parts A and B payments for 36.3 million claims for Medicare and VHA benefits that received services from VA's community providers between January 2017 and December 2021. The auditors compared claims data from the VA and Medicare to match payments that had been claimed in both datasets.
"Because CMS did not develop an interagency process, CMS did not establish an internal process (such as claims processing system edits) to address duplicate payments for medical services authorized and paid for by VHA. Furthermore, CMS guidance to providers on VA’s responsibility to pay for medical services did not clarify that a provider should not bill Medicare for a medical service that was authorized by VHA," OIG says.
CMS Agrees
The OIG recommends that CMS: Create a data-sharing agreement with VHA; Build an interagency process to integrate VHA enrollment, claims, and payment data into the CMS Integrated Data Repository to identify pMedicare otential fraud, waste, and abuse under the Medicare; and establish an internal process to address duplicate payments made by Medicare for medical services authorized and paid for by VHA; and issue guidance to providers on not billing Medicare for a medical service that was authorized by VHA.
CMS agreed with the recommendations and said it was taking up the recommendations.
