Some frontline providers affected by the COVID-19 pandemic could receive up to $2,000 to offset costs for mental health counseling.
Frontline healthcare workers who have been traumatized by the COVID-19 pandemic could be eligible for up to $2,000 in copayment assistance for behavior health counseling under an initiative announced Wednesday by the nonprofit HealthWell Foundation.
The financial aid for out-of-pocket, treatment-related copayments for prescription drugs, counseling services, psychotherapy, and transportation is available over the next 12 months to healthcare workers who have an annual household income of up to 500% of the federal poverty level ($64,400 for an individual, $132,500 for a family of four), the Germantown, Maryland-based independent charity said.
"History has taught us that the psychological impact of traumatic events doesn't always reveal itself immediately," said HealthWell board member Suzanne M. Miller, Ph.D. "For healthcare workers dealing with the often-tragic outcomes of COVID-19 cases, stress and anxiety can have serious, long-term effects on their mental wellbeing."
Healthgrades analyzed the performance of nearly 4,500 hospitals nationwide across 32 conditions and procedures.
Healthgrades this week released its 2021 America's Best Hospitals report, ranking the nation's top 50, 100 and 250 top performers for treating 32 of the most common conditions and procedures.
"Now more than ever, consumers understand the importance of researching hospitals and finding the best organization to meet their healthcare needs," said Healthgrades CMO Brad Bowman, MD.
Healthgrades analyzed the performance of nearly 4,500 hospitals nationwide across 32 conditions and procedures, including heart attack, heart failure, pneumonia, respiratory failure, sepsis, and stroke.
Patient in hospitals that make the Healthgrades list have a 27.4% lower risk of dying than if they were treated in hospitals that did not receive this award. If all hospitals were as successful as Healthgrades' top hospitals, 167,235 lives could potentially have been saved, the report states.
Healthgrades says the top hospitals on its list share common characteristics, including: a full embrace of patient-centered care; setting aggressive goals to improve outcomes; recognizing that all employees, from brain surgeons to janitors, are stakeholders in quality improvement; and having the courage to admit what isn’t working and removing obstacles to quality improvement.
"Especially in this era of COVID-19, we commend the recipients of the Healthgrades America's Best Hospitals Awards for their commitment to providing superior outcomes and keeping their communities safe," Bowman said.
Healthcare executives see telehealth competency as a foundational block for value-based care.
When it comes to developing competencies to prepare for value-based care, an overwhelming number of healthcare executives (81%) responding in a new HealthLeaders Intelligence Report say building their telehealth platform is their top priority.
That was no surprise to Kevin J. Conroy, MS, Chief Financial Officer and Chief Population Health Officer at CareMount Medical in Chappaqua, New York, who sees telehealth competency as a foundational block for value-based care.
"Given the costs of patient care, telehealth is an important option to have, especially in rural areas where access to providers is perhaps more difficult and in more urban areas where it's difficult to get an appointment," Conroy says.
Medicare's move last spring to reimbursement parity for telehealth during the coronavirus pandemic was a key driver for virtual care that "incentivized physicians to actually make the time to participate in telehealth as a means of providing care," Conroy says.
"Having the opportunity to stay in touch with a patient, particularly those with multiple chronic conditions, is critical," he says, adding, "I believe that to be true regardless of whether an organization is under a value paradigm or a fee-for-service paradigm."
Jaewon Ryu, MD, JD, President and CEO of Geisinger, a Danville, Pennsylvania, health system that has been on the vanguard of the value-based movement, says the pandemic has demonstrated the importance of telehealth.
"We've seen COVID serve as a catalyst really for all telehealth," he says. "The comfort level of people launching telehealth programs and the comfort levels of consumers and patients has inspired a lot of confidence, and so that 81% is absolutely real and this is one of the strange silver linings of COVID."
Ryu says providers rightly see telehealth as "an enabler" for other value-based competencies such as care coordination, clinical integration, patient engagement, and access. "That's the right way to look at it. It's really everything else that's further down the line," he says.
"Think of it as another mode of communication that allows either providers or care teams to connect with patients or care teams to connect with one another," he says. "When you enhance communication in that way, we've seen good things happen."
To download the full January/February 2021 HealthLeaders Intelligence Report, "Value-Based Care Advances, But Transition Proves Challenging," click here.
The accusations come just days after a RAND Corporation report noted that U.S. consumers pay 2.56 times more for prescription drugs than consumers in 32 other nations.
Hospitals are making big bucks by jacking up the price of prescription drugs and passing that inflated cost along to patients and their employers, according to a new report from the Pharmaceutical Research and Manufacturers of America.
The report claims that hospitals use a murky and confusing set of pricing schemes to routinely extract "two to three times more revenue from the sale of a medicine than drug makers" using markups, hospital consolidation, the 340B program, and other tactics.
The accusations levelled in the PhRMA report are the latest round in a finger-pointing blame game between payers, providers, and drug makers, that ultimately ends with consumers picking up the tab.
Last month, a RAND Corporation report noted that U.S. consumers pay 2.56 times more on average for prescription drugs than consumers in 32 other nations. That gap is even wider for brand-name drugs, with U.S. prices averaging 3.44 times those of other nations in the Organisation for Economic Co-operation and Development, RAND found.
"Brand-name drugs are the primary driver of the higher prescription drug prices in the United States," said lead authorAndrew Mulcahy, a senior health policy researcher at nonprofit, nonpartisan RAND.
Many of the accusations levelled in the PhRMA report have been raised for years. A spokesperson for the American Hospital Association declined to comment and said they were still reviewing the report.
PhRMA President and CEO Stephen J. Ubl said the report shows that "many actors – including hospitals, insurers and other middlemen – influence what patients pay out of pocket for prescription medicines."
"In recent years, nearly half of spending on brand medicines went to someone other than the research companies that developed the medicines," Ubl said. "This new report brings transparency to the role hospitals often play in determining the cost of medicines and ultimately what patients pay out of their own pockets."
"These routine markups increase costs for patients and employers and the amount a hospital receives from administering a medicine may exceed the net revenue earned by the manufacturer who researched and developed the medicine," PhRMA said. "The way in which hospitals set their prices is often opaque and unclear to patients, whose own out-of-pocket costs can be influenced by the rates charged by the hospital."
The drug makers' lobby also alleges that hospital consolidation means patients and payers are paying more for care, because bigger health systems can leverage their volumes to extract higher prices from commercial plans.
Healthcare, once a job-creating dynamo in the U.S. economy, has shed 542,000 jobs since February 2020.
The healthcare sector lost nearly 30,000 jobs in January, continuing a year-long trend for an industry that has seen 542,000 job losses since February 2020, new data from the Bureau of Labor Statistics show.
Ambulatory services saw an increase of 3,500 jobs for the month, but those gains were more than offset by 2,100 job losses in hospitals, 19,000 jobs losses in nursing homes, 13,000 in home healthcare services, and 7,000 job losses in communicate care facilities.
The healthcare sector for years has been a job-creating engine for the U.S. economy. But job growth in the sector collapsed in the spring of 2020 with the spread of the coronavirus pandemic, which forced hospitals and other care venues to shut down elective surgeries and procedures, and leery patients stayed away.
The January job report largely reflects the state of the economy in mid-month and is considered preliminary and subject to considerable revision.
In the overall economy, payroll employment grew by a sluggish 49,000 in January, and the unemployment rate nudged down 0.4 percentage point to 6.3% for the month.
Fitch Ratings sees financial good news for providers as the Biden administration moves to strengthen the Affordable Care Act.
President Joe Biden's executive order opening a three-month enrollment period for health insurance under the Affordable Care Act "would generally improve the financial position of not-for-profit hospitals," Fitch Ratings says.
In an issues brief published this week, the bond rating agency notes that hospital margins have been squeezed by several factors during the public health emergency, including higher volumes of uninsured patients who've lost job-sponsored coverage, high COVID-related caseloads, increased costs for medical scarce personal protective equipment and other medical supplies, regulatory uncertainties, and reductions in money-making elective procedures and surgeries.
"Reducing the number of uninsured and shifting the payor mix towards Medicaid coverage and privately insured will help mitigate revenue pressures," Fitch says.
Fitch notes that Biden did not campaign on an aggressive expansion of healthcare, such as the public option or Medicare for All.
Instead, his administration is expected to reduce the numbers of uninsured Americans with a focus on raising the upper-income eligibility for health insurance premium subsidies, increasing premium tax credits for coverage obtained through ACA Marketplaces, and raising the Medicaid poverty-level threshold, which could encourage the 12 hold-out states that have not expanded Medicaid to relent and adopt the ACA.
"This latter change would be credit-positive for hospitals in states where Medicaid has not been expanded, although political headwinds in key states like Texas persist," Fitch says. "It remains to be seen whether certain Medicaid waivers such as work requirements or block grants granted by the Trump administration will be rescinded by the Biden administration."
Democratic control of Congress and the White House also means that hospitals can breathe a little easier knowing that the ACA is no longer under threat of elimination, Fitch says.
The U.S. Supreme Court is expected to rule at mid-year on California v. Texas. However, even if the high court agrees with the plaintiff states that the individual mandate is unconstitutional and inseverable from the rest of the ACA, Democratic majorities in the House and Senate could easily remedy the matter legislatively.
More than 20 million people would lose health insurance coverage if the ACA were eliminated.
"This would generally reduce hospital revenues and could exert downward rating pressure on hospitals, particularly in states that expanded Medicaid coverage under the ACA," Fitch says.
Hospital stakeholders will also wait to see if the Biden administration rescinds other Medicaid waivers approved by the Trump administration, including Medicaid block grants and work requirements.
A proposal by the Biden administration to lower the age eligibility for Medicare to 60 is expected to have mixed results for providers "if a significant number of people move to Medicare from commercial payor coverage," Fitch says.
It's also not clear how much support that proposal has in Congress.
Cost-shifting by hospitals to cover lousy Medicaid reimbursements will become more problematic as price transparency mandates take effect.
Lower state Medicaid per-patient reimbursements correlate with higher cost-shifting to commercial and managed care plans, a new study from Crowe LLP's Revenue Cycle Analytics shows.
Cost-shifting is not new, of course. It's been going on for decades.
However, foisting higher costs on commercial payers in low-reimbursement states means consumers are paying more for healthcare, and that could prove problematic as more charge data becomes available to the public under federal and state price transparency mandates, says Brian Sanderson, managing principal of healthcare services at Crowe.
"Effectively, if you live in a state with lower Medicaid reimbursement rates and get your insurance through your employer, you're likely being charged more than what the exact same service costs in other states," Sanderson says.
The accounting and consulting firm's new report, Price Transparency in Healthcare: It Won’t Help Hospitals, examined patient transactions 707 hospitals in 45 Medicaid expansion states and 445 hospitals in non-expansion states, as of 2019.
The analysis found that the Medicaid outpatient net payments hospitals get varied greatly among 45 states, with payment discrepancies ranging from $200 to $650 per patient.
Several factors affect payments, including acuity, locality adjustments and types of programs, Crowe reports, "but one thing is clear: state-run Medicaid programs are not uniform across the country, in process or payment."
Crowe found a similar correlation when the analysis compared average outpatient managed care and Medicaid reimbursement by state as a percent of Medicare outpatient rates for a similar set of services.
For states with lower Medicaid reimbursement rates, including Florida (40%), California (39%) and Wisconsin (39%), the comparative rates for managed care were high at 268%, 261% and 251%, respectively.
Conversely in states with higher Medicaid reimbursement rates such as Iowa (78%) and Minnesota (97%), the managed care rates were lower at 166% and 188%, respectively, the analysis found.
"Hospitals and health systems will need to focus on highlighting their best attributes, like quality of care, convenient locations and well-rounded services offerings," Sanderson says.
"We envision a future where many parameters of a patient's decision are graded, similar to how we shop for cars," he says. "For example, a luxury SUV costs more than a no-frills sedan model – but differences in reliability, safety features and prestige might lead some customers to choosing the more expensive option."
Editor's note: This story was updated on February 3, 2021.
Most telehealth visits at 534 federally qualified health center care venues across California were audio only.
Health clinics serving lower-income patients have seen a surge in audio telehealth use during the pandemic, which allowed clinics to maintain access at a time when other healthcare venues saw significant drops in patient volumes, a new RAND Corporation research letter has found.
However, most of the telehealth visits at 41 federally qualified health centers operating in 534 care venues across California that were examined in the study were audio only, which RAND said raises concerns about care quality and access equity for patients, and the financial stress for clinics if payers stop paying for audio services after the public health emergency expires.
"While there are important concerns about the quality of audio-only visits, eliminating coverage for telephone visits could disproportionately affect underserved populations and threaten the ability of clinics to meet patient needs," said study lead author Lori Uscher-Pines, senior policy researcher at nonprofit RAND.
The research letter was published Tuesday in JAMA Network.
The study found that overall visit volume at the California FQHCs held stable during the pandemic, with half of primary care medical visits from March to August done via telehealth.
More than 77% percent of behavioral health visits were conducted via telehealth over the same period. Before the pandemic, RAND found there was minimal telehealth use.
For primary care medical visits, 48.5% were by telephone, 3.4% were by video and 48.1% were in person. For behavioral health, 63.3% were by telephone, 13.9% were by video and 22.8% were in person, RAND found.
Before the pandemic, audio-only telehealth visits were rarely reimbursed by commercial payers and government programs. However, at the onset of the coronavirus pandemic in March 2020, the Centers for Medicare & Medicaid Services announced that it would temporarily reimburse FQHCs for video and audio-only telehealth services.
It's not clear if CMS or commercial payers will continue to pay for audio-only telehealth services when the PHE expires.
"Lower-income patients may face unique barriers to accessing video visits, while federally qualified health centers may lack resources to develop the necessary infrastructure to conduct video telehealth," Uscher-Pines said.
"These are important considerations for policymakers if telehealth continues to be widely embraced in the future."
The total number of primary care visits dropped by 6.5% during the study period, while there was no significant change in total behavioral health visits.
The use of telehealth declined slightly during the study period after spiking at the start of the pandemic. Audio-only telehealth visits peaked in April 2020, making up 65.4% of primary care medical visits and 71.6% of behavioral health visits, the study found.
Editor’s note: This story was updated on February 3, 2021.”
Fitch Ratings estimates that the federal medical assistance percentage enhancement added $34 billion in federal aid to state Medicaid programs in 2020, and that a similar level of funding is projected for 2021.
The extension through the end of 2021 of billions of dollars in federal enhanced emergency funding for Medicaid will be welcomed by cash-strapped states, Fitch Ratings says.
In an issues brief released on Monday, Fitch estimated that the federal medical assistance percentage (FMAP) enhancement for Medicaid added $34 billion in direct federal aid to states in 2020, and that a similar level of funding is projected for 2021.
"Providing timely and direct fiscal aid to states limits their need to immediately pass on budget pressures to entities reliant on state funding, including school districts, public higher education institutions and healthcare providers," Fitch says.
Federal law sets the FMAP floor of 50% for states with the highest per-capita income, with a ceiling of 83%. In April 2020, the Families First Coronavirus Response Act (FFCRA) added 6.2 percentage points to every state's FMAP percentage.
Overall state revenues remain below pre-pandemic levels, but Fitch notes that the FMAP and better-than-expected sales tax revenues have helped states eke by since a public health emergency was declared last spring.
Fitch notes that the additional FMAP funding only affects states' spending on previously eligible Medicaid beneficiaries, and does not apply to Medicaid expansion spending under the Affordable Care Act, which the federal government matches at 90% for all states.
Medicaid enrollment for legacy categories is between 3x and 4x larger than expansion enrollment.
The Department of Health and Human Services last month told the nation's governors that the Biden administration anticipated the public health emergency would remain in place through 2021 and that HHS would provide states with at least 60 days' notice of termination.
The Trump administration routinely waited until the last minute before extending the 90-day PHE, and Fitch said states responded to the uncertainty and assumed little or no FMAP funding in their 2021 budgets.
The National Association of State Budget Officers reported in September that many states had anticipated a slowdown in revenue growth and made the appropriate adjustments.
"Even before the COVID-19 outbreak, states were planning on slower spending and revenue growth than what they had seen in several recent years," NASBO said.
"Based on information included in governors’ budget proposals, the median general fund spending growth rate was 3.1%, while the median general fund revenue growth rate was 2.9%, both below historical averages."
The Centers for Medicare & Medicaid Services, and the Kaiser Family Foundation have estimated that the 6.2 percentage point increase in FMAP in 2020 added about $32 billion in enhanced funding for Medicaid.
The delay is part of a larger move by the Biden administration to freeze for 60 days many of the regulatory changes put forward in the last days of the Trump administration that have yet to take effect.
The Department of Health and Human Services has pushed back by two months the implementation date for the controversial Medicare Part D prescription drug Rebate Rule for pharmacy benefits managers.
The delay for the rebate rule, which was supposed to take effect on January 29, is part of a larger order by the Biden administration on January 21 to freeze for 60 days many of the regulatory changes put forward in the last days of the Trump administration that have yet to take effect.
"The effective date of new paragraphs (h)(6) through (9), (cc), and (dd) of that rule, which would have been January 29, 2021, is now March 22, 2021," HHS wrote in the Federal Registry.
"The temporary delay in the effective date of this final rule is necessary to give Department officials the opportunity for further review and consideration of the revisions to paragraphs (h)(5)(vi) and (viii), as well as the addition of new paragraphs (h)(5)(iii), (6) through (9), (cc), and (dd) of 42 CFR 1001.952."
The Rebate Rule eliminates the current system of rebates for prescription drugs under Medicare Part D. HHS under the Trump administration claimed that excluding rebates paid by drug makers to pharmacy benefit managers would resolve a "perverse incentive" and create a "safe harbor" that protects discounts at the point of sale.
PBMs chafed at the Rebate Rule, however, and warned that it would increase premiums for 47 Million Medicare Part D beneficiaries and taxpayers in 2022. Stakeholders had asked a federal judge to delay the implementation date, and they cheered the news of the delay.
"Not only is the rebate rule itself misguided, but the aggressive timeline is virtually impossible to meet," Scott said.
The Campaign for Sustainable Rx Pricing praised the Biden administration's "decision to delay this misguided pharma-backed proposal to protect America’s seniors and taxpayers."
CSRxP executive director Lauren Aronson said the Rebate Rule "would do nothing to lower drug prices while also increasing premiums on Medicare Part D beneficiaries, costing taxpayers more than $200 billion and handing drug companies a more than $100 billion bailout."
