PODCAST: NaviHealth Digital Health Start-Up

SOLD TO OPTUM

BY ERIC BRICKER MD

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PODCAST: UHC’s David Wichmann Steps Down as CEO

THE WHOLE STORY?

By Eric Bricker MD

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

ORDER: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: On Digital Health Start-Ups

On Medical Entrepreneurs

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BY ERIC BRICKER MD

Your comments are appreciated.

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FTC to Probe Physician Practice Consolidation

Requests 6 years of patient-level claims data from insurers

By Ryan Basen,

The Federal Trade Commission (FTC) recently announced plans to examine the consequences of physician group consolidation with healthcare facilities.

The agency said it had sent orders for 6 years’ worth of patient claims data to six insurers to inform this review: Cigna, United Healthcare, Anthem, Florida Blue, Aetna, and Health Care Service Corporation.

Consolidation of US Physician Practices Continues to Surge

LINK: https://www.medpagetoday.com/practicemanagement/practicemanagement/90792?xid=nl_mpt_DHE_2021-01-21&eun=g1650026d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202021-01-21&utm_term=NL_Daily_DHE_dual-gmail-definition.

Your thoughts are appreciated.

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Waived Co-Pays for United Healthcare Medicare Advantage Plans

Waived Co-Pays for United Healthcare Medicare Advantage Plans

By Jessica M. Wade, MHA, Practice Manager

Just to clarify, the UHC copay waiver info is listed  clearly on the UHC website as follows:
“Members will have a $0 copay for covered primary care provider (PCP) and specialist physician services, as well as other covered services (listed below) between May 11, 2020 until September 30, 2020″. By lowering our PCP and specialist copays to $0, along with our telehealth cost-share waiver, we hope to help make it easier for you to access care”

Services included

The following services, if covered by your plan, are eligible for a $0 copay under the cost-share waiver, but do not include diagnostic tests and certain other services.

• Primary care provider (PCP) office visits
• Specialist physician office visits
• Physician assistant or nurse practitioner office visits
• Medicare-covered chiropractic and acupuncture services
• Medical and Podiatry services and routine eye and hearing exams
• Physical therapy, occupational therapy and speech therapy
• Cardiac and pulmonary rehabilitation services
• Outpatient mental health and substance abuse visits
• Opioid treatment services

The $0 copay applies to services from a network provider and out-of-network services covered by the plan. Member cost-share is not waived for the
following services, unless they are related to COVID-19 testing or treatments:

• Lab and Diagnostic tests (radiological and non-radiological)
• Part B and Part D drugs
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies
• Renal Dialysis
• Other services not covered by your plan

Co-pays, co-insurance and deductibles for services in the following settings are not waived. Members will be responsible for their share of the cost under their benefit:• Inpatient hospital and Outpatient surgery or observation services.

• Skilled Nursing Facilities
• Emergency, Urgent and Ambulance services

Source: https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/cost-sharing-waived

Furthermore, reimbursement is based on the Medicare fee schedule as these plans waiving copay are Medicare Advantage plans and subject
to Medicare guidelines and reimbursement models.

THANK YOU

 

Understanding Healthcare Conflicts of Interest

A Modern Ethical Dilemma

By Render Davis

www.BusinessofMedicalPractice.com

Conflicts of interest are not a new phenomenon in medicine. In the fee-for-service system, physicians controlled access to medical facilities and technology, and they benefited financially from nearly every order or prescription they wrote.  Consequently, there was an inherent temptation to over-treat patients.  Even marginal diagnostic or therapeutic procedures were justified on the grounds of both clinical necessity and legal protection against threats of negligence. 

Traditional Medical Care

While it can be construed that this represented a direct conflict of interest, it could also be argued that most patients were well served in this system because the emphasis was on thorough, comprehensive treatment – where cost was rarely a consideration.  It was a well known adage that physicians “could do well, by doing good.” 

Managed Medical Care

In managed care, the potential conflicts between patients and physicians took on a completely different dimension.  By design, in health plans where medical care was financed through prepayment arrangements, the physician’s income was enhanced not by doing more for his or her patients, but by doing less.  Patients, confronted with the realization that their doctor would be rewarded for the use of fewer resources, could no longer rely with certainty on the motives underlying a physician’s treatment plans.  One inevitable outcome was the continuing decline in patients’ trust in their physicians.  This has been exacerbated to some degree by revelations of significant financial remuneration to physicians by pharmaceutical and medical products firms for their services as researchers or active participants on corporate-funded advisory panels, calling into question the physician’s objectivity in promoting the use of company products to their peers or patients.

Higher Concerns

Conflicts of interest may also create concerns at a much higher level, as evidenced by the issues raised in 2008 litigation against Ingenix, a company that for more than a decade, provided information to the insurance industry on payments to out-of-network physicians for their “usual and customary rates (UCR).” As noted in court documents, Ingenix was a wholly-owned subsidiary of United Healthcare and the UCR information sold by the company to insurers may have been fundamentally biased in favor of the insurers, causing patients to pay larger out-of-pocket fees.  As a result, New York attorney general Andrew Cuomo filed suit against Ingenix.  This action was followed by suits brought against major insurers by the American Medical Association and several state medical groups for systematic underpayment to members, based on the biased data. 

Assessment

To date, there have been monetary settlements, but the issue continues to raise growing concerns regarding conflicts of interest among the key payers for health care.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Stuff that Still Floats to the Top on the ME-P

Interesting Articles of Yore

By Darrell K. Pruitt: DDS

I’ve posted hundreds of articles on the Medical Executive-Post over the last year, and it always surprises me when something I long ago forgot rises to the top of their popularity scale.

The Run-Down

Earlier today, a comment I posted on March 30 titled “Usual and Customary UnitedHealthcare” was the most popular article out of thousands (?).

https://healthcarefinancials.wordpress.com/2009/03/30/usual-and-customary-unitedhealthcare/

Why the sudden interest in UnitedHealth? Where is it coming from? 

At the same time, an article I posted on June 17 titled, “GM Bankruptcy Hits Delta Dental Hard,” had just showed up at 11th of the top dozen most popular articles. Why?  

https://healthcarefinancials.wordpress.com/2009/06/17/gm-bankruptcy-hits-delta-dental-hard/

Now, the UnitedHealthcare has dropped off the top dozen, and GM Bankruptcy has moved up to number 6.

Assessment 

Do you find that interesting? What do you think happened in the dental insurance market that has ME-P juggling my articles?

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Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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