BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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If an insurer uses 80 cents out of every premium dollar to pay its customers’ medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions.
The Affordable Care Act sets minimum medical loss ratios for different markets, as do some state laws.
Posted on September 13, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Nima Khodakarami PhD and Benjamin Ukert PhD
Evidence from Texas
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Medical care services before the health service is performed—became standard practice beginning with Medicare and Medicaid legislation in the 1960s.
Although research has uncovered disparities in prior coverage for cancer patients based on race, little has been known to date on the role of prior authorization in increasing or decreasing these disparities.
To learn more about the issue, Benjamin Ukert, Ph.D., an assistant professor of health policy and management in the Texas A&M University School of Public Health, and a colleague at Penn State conducted a retrospective study of data provided by a major national commercial insurance provider on 18,041 patients diagnosed with cancer between Jan. 1st, 2017, and April 1st, 2020.
The study is published in the journal Health Services Research.
Posted on June 10, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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Markets: Stocks dropped ever so slightly to end last week as investors tried to make sense of the big jobs report. Lots of jobs = good, but lots of jobs also = interest rates likely staying the same for awhile longer (more below). AMC had a rough day, tumbling 15% as the latest meme stock craze started to fizzle.
Blue Kansas City Exiting MA Market by 2025 Due to ‘Regulatory Demands’
Blue Cross and Blue Shield of Kansas City (Blue KC) is leaving the Medicare Advantage (MA) market at the end of 2024, the insurer announced recently. The company blamed “heightened regulatory demands and rising market and financial pressures” for the decision but said it is still focused on employer-sponsored health plans, and Medicare supplement and Affordable Care Act plans in the state.
“We explored every alternative path for our MA members and are disappointed we must exit this line of business,” said Erin Stucky, Blue KC President and CEO, in a statement. “We value our MA members and are committed to providing uninterrupted, quality service to our current MA membership through the end of 2024.”
Cue Health, founded in 2010, started with great hopes as it promised a way to accurately test for Covid-19 without needing a lab. “We designed and developed a new molecular testing platform bringing lab complexity to an easy-to-use, portable device. Now you can get the best of lab molecular testing — speed, accuracy, and versatility – at home, the office, or on the go,” the company shared on its website. The company went public (with the ticker (HLTH) ) in 2021 at $16 and rose to $20.55 and carried that massive $2.3 billion valuation. Through 2023 and into this year, Cue unsuccessfully tried to shore up operations, get new products to market, and find new capital.
In May, however, the FDA advised customers not to use two of its products at all because they did not deliver accurate results. Finally, its board and executives threw in the towel. On May 28th, the company announced it was ceasing operations and filed for bankruptcy in Delaware’s U.S. Bankruptcy Court. The company’s assets will be sold off at an undetermined date, and the proceeds will be distributed to creditors.
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Inflation data from the Fed meeting on Wednesday: Inflation data for May arrives in the morning, and it’s expected to show price growth held steady at 3.4% annually. In the afternoon, the FOMC will wrap up its meeting with a Jerome Powell press conference. The Fed is pretty much a lock to hold interest rates at their current level.
States that have long pushed the FDA to allow drug importation from Canada touted the move as a major step forward in their efforts to lower prescription drug spending and rein in healthcare costs. But while the idea of importing drugs from Canada is new for states, some businesses have been using existing drug import pathways to help consumers save money on certain high-cost medications.
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More than 20 million US residents—a record number, according to the Biden administration—have signed up for health insurance through the Affordable Care Act’s marketplaces. (the New York Times)
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Here’s where the major benchmarks ended:
Stocks were a mixed bag yesterday as investors pored over the first big earnings reports and new data showing that wholesale prices surprisingly went down in December. Airlines took a hit after Delta beat earning expectations but lowered its profit forecast.
The S&P 500 index rose 3.59 points (0.1%) to 4,783.83, up 1.8% for the week; the Dow Jones Industrial Average® (DJI) fell 118.04 points (0.3%) to 37,592.98, up 0.3% for the week; the NASDAQ Composite rose 2.57 points to 14,972.76, up 3.1% for the week.
The 10-year Treasury note yield (TNX) fell about 3 basis points to 3.943%.
The CBOE® Volatility Index (VIX) rose 0.26 to 12.70.
Retailers and consumer discretionary shares were among the market’s weakest performers Friday, and regional banks were also under pressure. The KBW Regional Banking Index (KRX) fell 2% for the week and ended at a one-month low. Energy shares led gainers behind strength in crude oil futures. The small-cap-focused Russell 2000® Index (RUT) ended little-changed for the week but is still down 3.8% so far this year.
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