UnitedHealthcare CEO Reveals $6.5 Billion Medical Cost Spike

Posted on October 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Fierce Healthcare [7/29/25]

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UnitedHealthcare CEO Tim Noel offered investors a deeper look at the medical cost spike that’s plaguing the insurance giant’s finances. He said during the company’s earnings call that pricing assumptions set by the company “were well short of actual medical costs” for 2025. UHC’s current outlook, he said, instead reflects an additional $6.5 billion in medical costs, with more than half, or about $3.6 billion, coming from its Medicare plans.

Noel said that in Medicare Advantage specifically, the team is looking to adjust pricing and benefit designs to account for the cost pressures, which they anticipate will stretch into much of 2026.

It has also decided to exit certain markets largely with plans that are more loosely designed, such as PPOs, in a move that will impact 600,000 beneficiaries.

Source: Paige Minemyer, Fierce Healthcare [7/29/25]

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PHYSICIAN: Pay Cuts in 2025

Posted on November 12, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Doctors, Facing Another Pay Cut, Call for Permanent Medicare Payment Reform

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. CMS has finalized the calendar year 2025 Medicare Physician Fee Schedule rule that sets payment rates for next year and also outlines new policies focused on primary care, preserved telehealth flexibilities, and a strengthened Medicare Shared Savings Program (MSSP). 

But, provider groups were quick to condemn CMS’ decision to go ahead with the pay cut, which was proposed in the draft rule released in July. In a statement, Bruce Scott, MD, president of the American Medical Association (AMA), pointed out that that while physicians are receiving a 2.8% payment cut next year, medical practice costs for physicians will increase by 3.5% in 2025. After adjusted for inflation, Medicare reimbursement to physicians has decreased 29% since 2001, the AMA says.

Source: Heather Landi, Fierce Healthcare [11/2/24]

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DAILY UPDATE: Nvidia, Intel, Oil, Bitcoin, Treasury Yields, CMS and Physician Pay

Posted on November 4, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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Nvidia is replacing Intel on the Dow Jones Industrial Average, a shakeup to the blue-chip index that replaces a flagging semiconductor company with the primary vendor of GPUs for AI.

CITE: https://tinyurl.com/2h47urt5

  • Despite selling off last week, stocks spent Friday comfortably in the green thanks to strong earnings from big tech.
  • Treasury yields rose back above 4.3% as bonds sold off and investors poured money into risk assets.
  • Oil rose a bit on reports that Iran may retaliate against Israel sometime soon.
  • Bitcoin was unable to hold the line and continued to fall today as crypto volatility continues to escalate ahead of the election.

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Bipartisan Legislation Aims to Stop Medicare Cuts & Boost Physician Pay in 2025

Physicians and other healthcare practitioners may get a pay boost in 2025 through a bipartisan bill recently introduced in Congress. The proposed bill seeks to block planned Medicare pay cuts next year and would provide the first inflationary update to physician pay in years. The Medicare Patient Access and Practice Stabilization Act would counteract the 2.8% cut to the conversion factor proposed by the Centers for Medicare and Medicaid Services (CMS) in the draft CY-2025 Physician Fee Schedule. A stop-gap pay fix is usually enacted by Congress at the end of the year. 

Source: Emma Beavins, Fierce Healthcare [10/30/24].

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Do Doctors Use ChatGPT in Clinical Decisions?

Posted on October 18, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Are doctors using publicly available tools like ChatGPT? The answer, Fierce Healthcare finds, is yes. In the first in-depth look of its kind into physician use of public genAI tools, Fierce Healthcare spoke with nearly two dozen doctors, students, AI experts and regulators, and helped conduct a survey of more than 100 physicians. The reporting confirms that some doctors are turning to tools intended for non-clinical uses to make clinical decisions. 

More: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2804309

A collaborative survey between Fierce Healthcare and physician social network Sermo found that 76% of respondents reported using general-purpose LLMs in clinical decision-making. With no standardized guidelines, lagging physician training and regulators racing to try to keep up with rapidly changing technology, guardrails to protect patients appear to be years behind current rates of utilization.

Source: Fierce Healthcare [10/8/24]

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DAILY UPDATE: Telehealth Down but Stock Markets Up for the Week

Posted on August 18, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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In April, UnitedHealth Group announced it was shutting down its Optum Virtual Care program. Days later, Walmart announced it would shutter both Walmart Health and Walmart Health Virtual Care.

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And in July, Teladoc posted a net loss of $838 million in Q2. The drop was largely driven by an impairment charge of ~$800 million for BetterHelp, the virtual mental health platform it acquired in 2015, Fierce Healthcare reported. Executives attributed the decline to increased customer acquisition costs, among other factors.

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Finally, Stocks are way out of whack with reality, the WSJ argues. Nevertheless, a slew of encouraging economic data helped propel the S&P 500 to its best week of the year—a welcome change from the whiplash volatility of the week before. Bayer jumped after scoring an appeals court victory in a case over claims its Roundup weed killer causes cancer.

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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HUMAN TOUCH: Needed in Medicine

Posted on July 16, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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According to Fierce Healthcare, 60% of patients say they are willing to switch doctors for a better communications experience, according to a survey. Patients want more of a “human touch” when texting their providers, like conversational message exchanges. 

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FTC: Non-Competition Contract Clause Agreements?

Posted on April 27, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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FTC Votes 3-2  to Ban Non-Compete Agreements, but Legal Challenges Expected

The Federal Trade Commission (FTC) just voted 3-2 to issue a final rule striking new non-compete agreements for all workers and phasing out existing non-competes for all but senior executives across “most employers.” The ban does not apply to non-profits including many of the country’s healthcare provider organizations due to the limitations of the FTC’s jurisdiction, one of several points of contention that has been raised by hospital industry groups that have opposed the ban.

The final rule will take effect 120 days after its publication in the Federal Register. To be in compliance, impacted employers will need to stop enforcing existing non-competes with workers other than senior executives, inform those who are no longer bound by existing non-competes and stop initiating new non-competes for all workers going forward, FTC staff said during an open meeting on the final rule held last week.

Source: Dave Muoio, Fierce Healthcare [4/23/24]

Moreover, the stay-or-pay contract practice requires nurses to put in a certain amount of time “or be required to pay money to their employer for an alleged debt, which could be tied to so-called training, a sign-on bonus, or other costs their employer claims are related to their employment,” according to National Nurses United (NNU), a union that represents about a quarter of a million registered nurses (RNs).

“The new FTC rule is a step in the right direction for nurses and those aspiring to take on this critical role in our communities,” NNU President Nancy Hagans said in a statement.

MORE: https://tinyurl.com/bdethdwh

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DAILY UPDATE: Anti-Competitive Practices in Healthcare and the NASDAQ and S&P 500 Losing Streak!

Posted on April 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

HAPPY EARTH DAY

By Staff Reporters

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Feds Open Online Portal for Reporting AntiCompetitive Practices in Healthcare

Federal agencies want to hear from the public about monopolistic and anticompetitive behavior within the healthcare industry. Last Thursday, the Federal Trade Commission (FTC), the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) unveiled HealthyCompetition.gov, an online portal where anyone can submit a healthcare competition complaint for potential investigation.

These submissions, the agencies said, can help the agencies ensure healthcare organizations provide quality care and pay their employees a fair wage.

Source: Dave Muoio, Fierce Healthcare [4/18/24]

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The S&P 500 just had its worst week in more than a year, and the NASDAQ is on a four-week losing streak. Blame skepticism that AI will meaningfully boost profits: Since the NASDAQ peaked last month, the largest US tech companies have lost more than $930 billion in market value. NVIDIA alone lost $212 billion in value on Friday, its biggest plunge since March 2020.

PS: Exxon Mobil is worth more than Tesla for the first time in more than a year.

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AUGMENTED INTELLIGENCE: In Medicine Today

Posted on April 6, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

THE AMA A.U.I. REPORT

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By Staff Reporters

Doctors are excited—yet cautious—about the role augmented intelligence (AUI) could play in the future of healthcare. That’s the takeaway from an American Medical Association (AMA) survey released last month.

About two-thirds (65%) of 1,000+ physicians that the AMA surveyed in August 2023 agreed that there was at least some advantage to using AUI-powered tools, particularly when it comes to diagnostic ability (72%), work efficiency (69%), and clinical outcomes (61%). More than half (56%) of doctors said AUI tools could best help address administrative burdens.

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PRIVATE HOSPITAL EQUITY: Adverse Events Rise?

Posted on January 10, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

DEFINITION: Adverse events are medical errors that healthcare facilities could and should have avoided. The National Quality Forum (NQF) defines these errors, which are also called serious reportable events. There are 29 adverse events listed as reportable errors. The events may result in patient death or serious disability. The department manages aggregate data on adverse events and posts quarterly reports on this website.

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A hospital’s acquisition by a private equity firm is linked to a rise in adverse events despite the pool of lower-risk patients they tend to admit, according to a Medicare Part A claims analysis just published in the Journal of the American Medical Association [JAMA], and according to Dave Muoio of Fierce Healthcare.

JAMA: https://jamanetwork.com/journals/jama/article-abstract/2813379

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DAILY UPDATE: ChristianaCare Settles FCA Lawsuit as Stock Markets Celebrate 2023 but Start Off Rocky in 2024

Posted on January 2, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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ChristianaCare agreed to pay $47.1 million to resolve illegal kickback allegations flagged by its former chief compliance officer.

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Markets: The stock market was closed yesterday to give investors time to celebrate New Year’s Day 2024. As the just passed old year, 2023, provided plenty of reasons to pop bottles and celebrate:

For example, global stock markets had their best year since 2019, and all three major US indexes finished the year higher than they started it, with tech company gains pushing the NASDAQ up the most. Even among tech giants, Nvidia was a standout, boosted by A.I. suddenly being everywhere.

But, all major markets are down as of this posting time, today.

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EDITOR’S CORNER: Fierce Health-Care’s 10 Most-Read Stories of 2023

Posted on December 25, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Heather Landi

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READ HERE: http://tinyurl.com/484773vm

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MEDICARE [dis] ADVANTAGE Plans?

Posted on December 3, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Leading hospital trade groups are accusing some Medicare Advantage plans, including giant UnitedHealthcare, of flaunting coverage requirements recently codified by CMS. The American Hospital Association is now petitioning the Biden administration to crack down.

However … the Medicare Advantage market is booming but investment in cancer care continues to lag.

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HEALTHCARE Innovation and Practice Management on the Move

Posted on December 1, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Online therapy company Talkspace will provide free virtual mental health services to more than 400,000 adolescents and teens in New York City after inking a deal with the city. The new program, dubbed TeenSpace, will connect teens to a licensed therapist through phone, video and text.

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The Patient-Centered Outcomes Research Institute (PCORI) has announced funding awards of $80.5 million to support four new studies focused on disparities in maternal health. They will take into account clinical and social factors that contribute to inequities and will compare interventions in various settings.

And … Ayble Health, a digital health platform for patients with chronic gastrointestinal conditions, is working with the Mayo Clinic Complex Care Program to offer a hybrid care model that matches patients with the appropriate virtual and in-person care based on acuity and need.

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HEALTHCARE: Business News

Posted on November 8, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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House Democrats want CMS to better monitor Medicare Advantage plans’ use of AI tools to ensure they don’t allow an unusually high level of restrictive and repeated denials.

Kaiser Permanente continues to rebound from a rough 2022 and pulled in $239 million in net income in Q3. That marks a dramatic turnaround from the $1.5 billion net loss the integrated system had seen a year prior.

CITE: https://www.r2library.com/Resource

And … during the Milken Institute’s Future of Health Summit Monday, former HHS Secretary Alex Azar and current department chief Xavier Becerra sparred over the Biden administration’s approach to negotiating Medicare drug prices.

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Finally, family physicians utilizing value-based payment (VBP) models reported burnout relief in a study from EHR company Elation Health and the American Academy of Family Physicians. Burnout among providers decreased once practices passed a threshold of 75% financial investment in VBP models.

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President Bidens Executive Order on Artificial Intelligence

Posted on October 30, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Biden will issue sweeping executive order on A.I. Today

The Biden administration just released an executive order today to regulate AI technology. The directive aims to leverage the government’s role as a leading technology customer by requiring advanced AI models to undergo assessments before they can be used by federal employees. It would also ease barriers to immigration for highly skilled workers in an attempt to boost the US’ technological edge.

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MORE Fierce Healthcare NEWS

The Biden administration has proposed a new rule refining several aspects of the healthcare services billing process in response to criticisms levied from all sides of the industry.

The federal government is rolling back a pandemic-era waiver that lowered the bar for 340B hospitals to dispense discounted drugs across some outpatient clinics. Hospitals argue the decision will “stifle” future efforts to expand access to under served communities.

And … Amazon Pharmacy is focused on making it faster and more convenient for patients to get prescription medications. The company’s moves come as brick-and-mortar drugstores are limiting pharmacy hours and even closing locations.

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DEA Temporarily Extends Tele-Health Prescribing Flexibility

Posted on May 7, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Tele-Health medical providers are cheering the Drug Enforcement Agency (DEA) move to temporarily extend virtual prescribing flexibility.

The DEA is looking to buy some time to consider whether it should require patients to see doctors face-to-face to get prescriptions for controlled drugs or continue to allow Tele-Health prescriptions. The agency received a record 38,000 public comments on its proposed rule.

Source: Heather Landi, Fierce Healthcare [5/3/23]

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H2 Healthcare Data Breach Report

Posted on February 17, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

MCOL Cyber Attacks

By Staff Reporters

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Critical Insight: 2021 with 5 Findings

 •  In 2021, 45 million individuals were affected by healthcare cyber-attacks, up from 34 million in 2020.
 •  The total number of affected increased 32% over 2020, meaning that more records are exposed per breach each year.
 •  Breaches only rose 2.4% from 663 in 2020 to 679 in 2021 but still hit historic highs.
 •  Hacking/IT incidents continue as the most common cause of breaches with an increase of 10% in 2021.
 •  Hacking incidents at outpatient/specialty clinics saw a 41% increase in these types of breaches in 2021.

Source: Critical Insight via Fierce Healthcare, February 1, 2022

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