Where we’re going

The Best Response to the NSA is Still a Strategic and Compliant Approach One year ago, the United States marked a turning point for health care cost transparency with a new law aimed at helping Americans avoid unnecessary, unexpected medical debt. The No Surprises Act (NSA) was signed into federal law after years of negotiation between health … Continued

Providing employees with access to affordable, quality healthcare is one of the greatest economic challenges for employers today. Finding the right balance between a benefit package that is both adequate and affordable — yet financially sustainable — has never been easy. Now, these efforts are compounded by COVID-19 and its significant post-pandemic challenges.    While Plan … Continued

In March 2022, the Consumer Financial Protection Bureau (“CFPB”) issued a 54 page report regarding the impacts of medical debt on consumers. The CFPB research showed that $88 billion in medical debt was on consumer credit records as of June 2021 and most medical debt collection tradelines[1] are under $500. In response, Equifax, Experian, and … Continued

Since the passage of Health Reform 13 years ago, annual deficits have added $19T+ to the national debt. America is now $31T+ in debt, in addition to significant underfunding of entitlements like Social Security and Medicare. There is a fierce debate underway in the beltway about raising the debt ceiling. President Biden proposes a budget … Continued

A growing number of primary care physicians are negotiating direct working relationships with self-funded employer-sponsored health plans. Direct Contracting is a payment model that shifts risk to a primary care group of physicians to provide a defined set of medical services in exchange for a monthly capitation fee. The model supplants the traditional fee-for-service reimbursement … Continued

Prior to the No Surprises Act (NSA), many patients who required air ambulatory transportation received medical bills, much to their surprise, that charged excessive fees for services not covered by their insurance plan. “Surprise” bills can be difficult to dispute, especially charges billed by out-of-network providers such as ambulance services, leaving patients already “financially fragile” further strained … Continued

On January 5, 2023, President Biden signed the State Offices of Rural Health Program Reauthorization Act of 2022 (the “Act”) into law. The Act reauthorizes grants awarded to state offices of rural health for improving health care in rural areas through fiscal year 2027. The prior law requires recipients of grants to use the funds … Continued

On January 19, 2023, the American Economic Liberties Project[1] released the report “Critical Condition: How UPMC’s Monopoly Power Harms Workers and Patients” (the “Report”). The Report addresses the problems with UPMC and the consequences to its workers and patients. According to the Report, “[i]n the last ten years alone, UPMC used a relentless string of … Continued

As healthcare inflation continues into 2023, medical providers are increasing their fees to maintain revenues. This financially impacts most employers and plan participants who can expect to pay more for health coverage and provider services this new year. According to a recent survey and analysis conducted by AHIP, during the first three quarters of 2022, … Continued

In November, in accordance with the Biden administration’s executive order on competition, the Department of Health and Human Services (HHS) published the Hospital Owners Information dataset (the Dataset). The Dataset is aimed at making transparent the ownership structure of Medicare-certified hospitals. The Dataset contains the following information about the more than 7,000 hospitals: Organization name, … Continued