Before May, telehealth as a percentage of medical claims had steadily fallen from February through April.
Telehealth as a percentage of all medical claims rose 2% nationally from April to May after dropping for the three previous months, according to nonprofit FAIR Health's Monthly Telehealth Regional Tracker.
Overall, telehealth represented 5% of all medical claims in May, up from 4.9% in April, according to tracker data, which examines privately insured plans, including Medicare Advantage, and excluding Medicare fee-for-service and Medicaid.
Before May, telehealth as a percentage of medical claims had steadily fallen from February through April.
Regionally, the South (5.6%) and the West (4.8%) saw the largest increases in telehealth claims, while the Northeast and the Midwest saw declines of 5.4% and 1.7%, respectively.
Substance use disorders were among the top five telehealth diagnoses nationally for the first time, coming in fifth place. The pattern was consistent with reports of increased misuse of opioids and stimulants during the COVID-19 pandemic, FAIR said.
The percentage of telehealth claim lines accounted for by mental health conditions rose nationally and in every region in May 2021. Mental health conditions remained the number one telehealth claim nationally and in every region.
Acute respiratory diseases and infections climbed in the national rankings of telehealth diagnoses from number four to number three, joining the top five diagnoses in the Northeast and West. The diagnosis had already been in the top five in the Midwest and South in April and continued there in May.
FAIR said the rise in respiratory claims suggested a return to non-COVID respiratory conditions, such as colds and bronchitis, as cases of COVID-19 fell.
In May 2021, the top five telehealth procedure codes by utilization remained the same as in April nationally and in every region but the Midwest. There, CPT®2 99213, an established patient outpatient visit with a total time of 20-29 minutes, fell from second to fourth place.
CMA claims that Aetna's actions violated the state's Unfair Competition Law.
The California Supreme Court has granted a California Medical Association request to review a decade-long lawsuit against Aetna challenging the health insurer's denials of out-of-network benefits.
The story begins in July 2012, when CMA, the Los Angeles County Medical Association, and other providers sued Aetna for what the plaintiffs alleged was "a systematic practice by Aetna of harassing and terminating contracted physicians from the Aetna network when they refer patients to out-of-network ambulatory surgery centers."
Fast-forward to November 2019, and after seven years of mind-numbing litigation, the Los Angeles Superior Court ruled that CMA did not have legal standing to pursue claims against Aetna on behalf of its physician members.
However, CMA has argued that the Los Angeles appellate court wrongly concluded that CMA's use of its own money didn't count as injury to the organization because CMA "was founded to advocate on behalf of its physician members" and that CMA staff time spent fighting these abuses "was typical of the support CMA provides its members in furtherance of CMA's mission."
CMA claims that Aetna's actions violated the state's Unfair Competition Law, which grants standing to any person or organization that "has suffered injury in fact and has lost money or property as a result of the unfair competition."
"Aetna's practices at issue in this case both harmed CMA and its members and frustrated the other more expansive purposes of the organization, as CMA was forced to expend resources and money in order to protect its members from Aetna's unfair practices," CMA said in a media release. "That is all that is required to establish standing under the UCL."
"If the appellate court's decision is allowed to stand, it would effectively preclude any membership organization from ever seeking relief under the UCL and undercut a central plank of private enforcement of one of the state's most important consumer-protection laws," CMA said.
CMA is calling the decision to hear the petition "a major victory" because the state's highest court reviews only about 3% of the more than 1,000 civil petitions for review it gets each year.
Four Michigan hospitals were named in the suit, which stems from the questionable practices of one gynecologic oncologist.
Ascension Michigan will pay $2.8 million to settle whistleblower False Claims Act allegations that four of its hospitals filed claims for medically unnecessary procedures performed over more than six years by a gynecologic oncologist, the Department of Justice said.
According to federal prosecutors, from Feb. 1, 2011, through June 30, 2017, Ascension Michigan knowingly falsely billed Medicare and other federal government healthcare programs and improperly kept payments for professional and facility fees related to medically unnecessary radical hysterectomies that "the Doctor" – not named by DOJ -- performed, including chemotherapies that the doctor administered, and evaluations and management services by the doctor that were not performed or misrepresented.
The federal complaint notes that the doctor's higher-than-average rates of pulmonary embolisms and surgical infections, and patients' complaints, aroused the suspicions of Ascension Michigan managers. They hired an independent doctor to conduct a peer review that found that, for most of the radical hysterectomies and chemotherapy performed by the doctor, a less aggressive surgery or medical intervention would have been the care standard.
In June 2018, Ascension self-disclosed the fees it billed to federal healthcare programs for services provided by the doctor. Though the health system at first improperly kept the money, it cooperated in the DOJ investigation and "took active steps" to address concerns raised about the doctor, including the peer review, placing the doctor on a performance improvement plan, and canceling its contract with the doctor.
"When hospitals receive payment from federal healthcare programs for medically unnecessary surgical procedures, they cannot simply retain those payments; they have an obligation to return them," DOJ's Civil Division Acting Assistant Attorney General Brian M. Boynton said. "We will continue to ensure that taxpayer funds are used appropriately for the important programs that they support."
The four Michigan hospitals named in the settlement are: Providence Park Hospital; St. John Hospital and Medical Center; St. John Macomb Oakland Hospital; and Ascension Crittenton Hospital.
Ascension Michigan did not respond to HealthLeaders' request for comment on the settlement.
Overall, the healthcare sector created 37,000 new jobs in July, with the gains by hospitals and 32,000 new jobs in ambulatory services offsetting the loss of 13,000 jobs in nursing and residential homes, the Bureau of Labor Statistics reports.
The BLS report accounts for employment in mid-July and can be subject to considerable revision.
The healthcare sector has shed 502,000 jobs since the start of the pandemic in February 2020, with hospitals accounting for 86,000 job losses, and nursing homes accounting for 378,000 job losses. Ambulatory services sector lost 37,000 jobs in that span.
There were 15.9 million people attached to the healthcare sector workforce in July, BLS said.
For the second straight month, the larger economy saw solid job growth in July, with 943,000 new jobs created, as the unemployment rate ticked down to 5.4% from 5.9% in June, and the number of unemployed people fell by 782,000 to 8.7 million.
Nonfarm payroll employment is up by 16.7 million since April 2020 but down by 5.7 million, or 2.7%, from its pre-pandemic level in February 2020.
The new deal extends the contract through the end of 2024.
Anthem Blue Cross and Sutter Health have agreed on a multi-year extension to their existing contract that was set to expire in 18 months, the two sides announced.
The new deal extends the contract through the end of 2024.
"We are pleased to continue working with Sutter to make healthcare simpler and more accessible," John Pickett, Anthem's regional vice president of provider solutions, said in a media release.
"We value the relationships we have with the providers in our network, which are important to creating choices for our consumers and fulfilling our mission of improving the lives of the people in the communities we serve," Pickett said.
The contract applies to Anthem customers enrolled in Medi-Cal, HMO and PPO plans and provides continued in-network access to providers and affiliates of Sutter Health, the largest health system in Northern California.
Sutter spokeswoman Grace Davis said the extension "will give our Sutter patients stability and access to our integrated network for years to come."
The health system is urging its customers to "take action" and "call Anthem at the number on the back of your insurance card and urge them to work with Dignity Health doctors and hospitals on a new agreement."
San Francisco-based Dignity Health has brought its ongoing contract dispute with Anthem Blue Cross before the court of public opinion.
In several posts on its website, Dignity – the largest not-for-profit health system in California – announced that its contract with for-profit Anthem expired in mid-July, and that patient access would be adversely affected as negotiations sputter.
"Anthem has claimed that Dignity Health's rates are exceptionally high in California, but this is simply not true," the health system said in its plea to consumers. "Dignity Health's rates are competitive with other hospitals in our markets. According to the most recent RAND Corporation study reviewing hospital prices nationally, at least eight other health systems in California have health plan rates that are higher than Dignity Health."
"Because of Anthem's unwillingness to negotiate a new, responsible contract, more than 1 million patients lost in-network access to care at most of Dignity Health's California facilities on July 16, 2021."
Describing its fight as a battle with the "nation's largest for-profit insurance company," Dignity noted that Anthem recorded $1.7 billion in profits in Q1, "exceeding even Wall Street analysts' projections. Profits are distributed to shareholders, not reinvested in patient care or expanded access."
"We are doing everything we can to restore our in-network status, including offering Anthem a proposal with rates that do not even cover hospital inflation costs and are below increases included in our prior agreements."
Dignity said the expired contract means that more than 1 million consumers will have limited – if any – access to its venues in more than 30 communities and will be "forced to travel great distances to receive the care – especially specialized care like oncology services, neonatal ICUs, pediatric care, burn centers, accredited stroke centers and more."
The health system is urging its customers to "take action" and "call Anthem at the number on the back of your insurance card and urge them to work with Dignity Health doctors and hospitals on a new agreement."
"If you receive insurance through your employer, for more information, talk to your human resources or benefits department and urge them to contact Anthem," Dignity said.
The average rate change for the past three years is only 1.1%, which also marked the third year since the launch of California's state subsidy program.
Covered California projects that preliminary health insurance rates for 2022 will increase by an average of 1.8% statewide.
The state's health insurance marketplace credited the relatively low rate hike to expanded subsidies sent to the state under the American Rescue Plan, which lowered premiums by an average of 50% for hundreds of thousands of Californians--with some paying as low as one dollar in premiums per month.
Gov. Gavin Newsom said "California is continuing to make significant progress towards covering everyone in our state, and a key part of that is to make sure folks can take advantage of the federal support through the American Rescue Plan."
"The pandemic highlighted how important it can be to have access to quality, affordable healthcare coverage, and Covered California is making that happen for more people than ever before," Newsom said.
The preliminary average rate change of 1.8% will apply to California's individual market, which covers 2.3 million people – the highest enrollment in the marketplace's history -- including the 1.6 million enrolled through Covered California and "off-exchange" enrollees who sign up directly through a health insurance carrier.
From 2020 to 2022, Covered California payers said that the improved risk mix from new enrollment has contributed to lowering premiums by 3% to 5%. Other factors have caused premium trends to be below the usual medical cost trend of 5% to 7%, such as the impact of the COVID-19 pandemic and deferred care.
The average rate change for the past three years is only 1.1%, which also marked the third year since the launch of California's state subsidy program.
"Healthcare costs are never a one-year story," said Peter V. Lee, executive director of Covered California. "The past three years show how California has led the way not only by providing stability and lower costs to our consumers, but also through the state's modeling of expanded financial help, which is now reflected in the American Rescue Plan."
"By getting more people insured and lowering the costs of coverage, we are creating a virtuous cycle of more people being insured, healthier consumers and lower rates for everyone," Lee said.
The rate hike reflects changes in premiums before federal subsidies, which cover about 89% of the premium for those getting financial help. In addition, premiums will vary by region and by an individual’s personal situation.
The rate change for unsubsidized enrollees who switch to the lowest-cost plan in the same metal tier is -7.9%, which will allow many enrollees to shop for a lower gross premium.
California Association of Health Plans President/CEO Charles Bacchi said the low rate hike "makes it abundantly clear that the Affordable Care Act is thriving in California."
"With the expanded coverage options providing most enrollees with four to five health plan choices, there is ample opportunity for consumers to shop around for even lower premiums, he said. "With record enrollment in California's individual marketplace along with new state polices extending Medi-Cal to more undocumented Californians, we are well on our way to closing the uninsured gap in California."
The special enrollment period runs from November through the end of 2021.
Virtual care advocates note that telehealth demonstrated its value as a care option for seniors during the pandemic, when in-person care venues were shuttered.
More than 430 telehealth stakeholders are asking Congress to make permanent the reforms put forward during the public health emergency that facilitate remote healthcare.
In a letter sent this week to lawmakers, the stakeholders urged Congress to act before the PHE expires – tentatively this autumn -- and threatens to create a "telehealth cliff" for Medicare beneficiaries who've come to rely on virtual care options.
Specifically, the stakeholders are asking Congress to:
Remove "arbitrary restrictions" on where a patient must be located to be eligible for telehealth services;
Ensure that federally qualified health centers, critical access hospitals, and rural health centers can furnish telehealth services;
Authorize the Department of Health and Human Services to allow additional telehealth practitioners, services, and modalities;
Remove restrictions on telemental health services.
The stakeholders note that telehealth has demonstrated its value as a care option for seniors during the pandemic, when other care venues were shuttered.
"Because of this, many providers and health systems have made substantial investments in telehealth. Congress must act now to pass legislation to ensure patients and providers are not left in the lurch with fewer options to address critical health needs," the letter said.
The letter was co-led by the Alliance for Connected Care, American Telemedicine Association, Consumer Technology Association, eHealth Initiative, HIMSS, Health Innovation Alliance, Partnership to Advance Virtual Care, and PCHAlliance.
"One acknowledged bright spot resulting from COVID-19 has been the extraordinary use of telehealth that has allowed patients to access quality care from the convenience of their homes," Kyle Zebley, ATA vice president of public policy said in a media release.
"However, there is now much uncertainty around the future of telehealth, creating chaos and concern for patients and healthcare providers alike, as the 'telehealth cliff' threatens to abruptly cut off access to care, especially for our underserved and rural populations," Zebley said.
The 32nd annual version of widely read rankings featured mostly the same top 20 hospitals that make the list in year's past.
For the sixth straight year, Mayo Clinic sits atop the 20 Best Hospitals rankings published Tuesday by U.S. News & World Report.
The 32nd annual version of widely read rankings, which emphasizes outcomes, patient experience and risk adjustment, featured mostly the same top 20 hospitals that make the list in year's past.
Vanderbilt University Medical Center is the only new hospital to crack the Honor Roll, while Keck Medical Center of USC, Los Angeles, ranked 18th last year, was dropped from the Top 20.
Using data primarily from Medicare's Standard Analytical File, much of which predates the pandemic, hospitals across the nation in were ranked on 26 adult specialties, including: cancer, cardiology and heart surgery, diabetes and endocrinology, ear, nose and throat, gastroenterology and GI surgery, geriatrics, gynecology, nephrology, neurology and neurosurgery, ophthalmology, orthopedics, psychiatry, pulmonology and lung surgery, rehabilitation, rheumatology, and urology, U.S. News said.
This year's methodology includes seven new "bellwether" ratings that include back surgery (spinal fusion), diabetes, heart attack, hip fracture, kidney failure, pneumonia and stroke.
Honor Roll Hospitals received points if they were nationally ranked in 15 specialties – the more specialties and the higher their rank, the more points they got – and if they were rated high performing in any of 17 procedures and conditions. The top point-scorers made the Honor Roll.
The study evaluated nearly every community hospital in the nation. Only 134 hospitals out of more than 4,300 were nationally ranked in one specialty, while 563 were ranked among the Best Regional Hospitals in a state or metro area based on their performance in delivering complex and common care, U.S. News said.
Here’s the 2021-22 Best Hospitals Honor Roll. The numbers in parentheses are the 2020-21 rankings.
By greatly boosting the numbers of people using telehealth, COVID-19 may have jumpstarted broader adoption of telehealth for mental health conditions.
Latinos were the most engaged in using remote mental health services during the height of the pandemic in 2020, according to a new analysis commissioned by Anthem Inc.
The study -- Anthem, Inc. State of the Nation’s Mental Health – looked at Medicaid trends in 14 states in 2020 and found that, for people with existing mental health conditions, telehealth access to rose precipitously for all races and ethnic groups during the pandemic and accounted for 49% of all Medicaid mental health visits during a six-month period in 2020.
The study speculates that by greatly boosting the numbers of people using telehealth, COVID-19 may have jumpstarted broader adoption of telehealth for mental health conditions – especially with Hispanics/Latinos.
"In fact, during COVID-19, almost 40% of Hispanic/Latino members had a telehealth visit, while White members had 34%, Asian members had 33% and Black members had 28%, the study said.
"Overall gaps in getting mental health care between races and ethnic groups remained essentially the same before and during COVID," the study said. "A higher percentage of Hispanic-Latinos were already receiving in-person or telehealth mental health visits before COVID-19."
Despite the dramatic boost in telehealth visits during the pandemic, it didn't make up for the dramatic drop in in-person visits for all races and ethnic groups, and the study found there there were significant differences among them.
"In fact, Black people had the lowest percent of combined telehealth and in-person visits – 56% – before COVID-19 and remained the lowest with 49% after COVID-19," the study said.
"On average, Black people had 7% fewer mental health visits compared to White people with similar demographic, clinical and socio-economic backgrounds. The rates are particularly noteworthy as surveys have indicated that people of color were experiencing more stress and mental health conditions than other populations in 2020 and people of color were disproportionately impacted by COVID-19," the study said.
Historically, major depression and anxiety are underdiagnosed at rates of 32%-40% less in Black and Hispanic/Latino communities, according to the BCBS Health Index.
The American Psychological Association says that lower diagnosis rates are likely driven by lack of provider understanding of cultural differences, stigma around diagnosis or treatment and barriers getting care.
Anthem Chief Health Officer, Shantanu Agrawal, MD, said there could be a number of reasons why Black people are lagging in mental health care visits, both in-person, and remote, including a history of "culturally insensitive care."
"Health equity is a key driver for mental and physical well-being," Agrawal said. "To achieve equity in our healthcare, we need to understand where and why barriers to health exist, and then couple these insights with the scale and scope of Anthem to drive changes to a new system of health, that puts equity at the center."
The most common telehealth diagnoses for Medicaid members with existing mental health conditions were anxiety, depression and bipolar disorder, according to the special State of the Nation’s Mental Health report. High blood pressure was among the top five diagnoses for Black, Asian and Hispanic/Latino people, while high cholesterol was a top five medical diagnosis for Hispanic/Latino and Asian people. Opioid use disorder was one of the top five diagnoses for White people, while severe back pain was a top diagnosis for Black people. These data reinforce that mental health and physical health are connected and improving one can help the other.
"While telehealth wasn't a panacea in eliminating health equity gaps, it helped boost connectivity for all and made Internet visits possible when COVID temporarily closed physical doors, allowing health care to continue to be delivered with some semblance of normalcy," Agrawal said.
"This study is a key reminder that technology alone won't be sufficient to bridge this gap and the bridge may not be the same for all people. However, it may be the connector needed by certain communities or geographic areas. Clearly, outcomes during the pandemic would have been much worse without telehealth," he said.
