Self-Insured Health Plans and Primary Care Physician Practices Find Mutual Advantages of Direct Contracting

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

Survey Reports Significant Percentage of Ground Ambulatory Service Claims Resulted in “Surprise” Billings, Federal Legislation Continues to Forge New Protections

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

Extension of Federal Rural Health Grant Program Signed Into Law

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

The Problems With UPMC

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

Publication of Hospital Ownership Information: Another Layer of Transparency

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

How The Inflation Reduction Act’s Drug Coverage and Marketplace Subsidy Provisions Are Putting Pressure on Employee-Sponsored Healthcare Plans

Long ago, the designers of health reform predicted that, by 2025, only a minority of the employers who offered coverage in 2010 would still be providing coverage in 2025. It now seems like each iteration of the Affordable Care Act, as well as subsequent legislation, is nudging businesses toward that outcome. Specifically, the Inflation Reduction Act … Continued

Prepare Now for Surging Medical Costs: HSA and 401k Strategies Achieve Superior, Synergistic Savings

It’s never too early for plan sponsors to incorporate the most effective strategies for addressing today’s healthcare inflation and economic challenges. To alleviate “financial fragility” when it comes to the medical expenses that their participants are not prepared to pay, a Health Savings Account (HSA) strategy is capable of “Quadruple Duty” – covering Medicare premiums, … Continued

Cleveland Clinic to Charge for Patient Messages

The Cleveland Clinic announced that on November 17, 2022 it would begin billing patients’ insurance for messages that require five minutes or more of a healthcare provider’s time to answer.  The announcement provides: [S]tarting November 17, 2022, MyChart responses that require your provider’s clinical time and expertise to answer may be billed to your insurance. … Continued