News & Commentary

Briefly Noted December 2018

Some astronomical hospital bills that blindsided patients and recently sparked outrage are caused by health plans not having wide enough physician networks—networks that include oncologists and radiologists and other specialists, argue R. Bruce Williams, MD, and Geraldine B. McGinty, MD, in a recent opinion piece for Stat. Williams is president of the College of American Pathologists and McGinty is chairwoman of the American College of Radiology’s Board of Chancellors. “Patients should not be financially responsible when an insurance plan cannot provide in-network physician services at in-network hospitals or other facilities,” wrote Williams and McGinty. “Instead, the insurance plan should foot that bill”.

A change in how mental health services for Medicaid patients are billed and how providers are paid for those services is affecting about 700,000 Ohio residents, reports, a news website associated with the Cleveland Plain Dealer. The changes are part of Gov. John Kasich’s efforts to modernize behavioral health care, but providers say the transition is full of processing and reimbursement delays and is putting a financial strain on a field already overwhelmed by the opioid epidemic. Part of the problem seems to stem from the state’s efforts to move more beneficiaries into Medicaid managed care, which involved adding 100 new codes to the system.

Minnesotans eligible for Medicare should take a close look at the Medicare Advantage plans that they have to choose from, reports the Star Tribune of Minneapolis. Some Medicare Advantage plans come with a smaller network of providers than what beneficiaries would find under traditional Medicare. Those “limits seem to be one reason some shoppers are considering a return to original Medicare plus a Medigap supplementary policy, which brings more choice but generally with higher premiums,” the newspaper reports.

Yet another study saying that the benefits of weight-reduction surgery may go further than just losing weight. Researchers with Kaiser Permanente Washington Health Research Institute tracked about 20,000 severely obese patients who had type 2 diabetes. Those who had the weight-reduction surgery had a 40% lower chance of getting a stroke or heart attack five years after the surgery compared with patients who got the usual diabetes care. The results were published in the October 16 issue of JAMA. David Fisher and his colleagues say the findings mean that health care professionals “should engage patients with severe obesity and type 2 diabetes in a shared decision-making conversation about the potential role of bariatric surgery in the prevention of macrovascular events”.

Employers have changed their approach to controlling health care costs, from shifting cost burden to employees to managing benefit packages, said Sarah Thomas, managing director of the Deloitte Center for Health Solutions in an opinion piece on the Deloitte website. She sees employers focusing on two main goals: reducing the costs for their sickest employees and keeping their healthy employees healthy. For the former, some employers have relied on value-based insurance designs, partnering with innovative providers, and steering certain employees toward ACOs. For the latter, some employers have considered building onsite health centers and employing health advocates.

Millennials, the 83 million Americans born between 1981 and 1996, don’t seem to see much of a need for having a primary care physician, unlike earlier generations, according to a national poll by the Washington Post. The poll found that 45% of 18- to 29-year-olds have no primary care provider. That’s compared with 28% for those aged 30 to 49, 18% for those who are 50 to 64, and 12% for those who are 65 and older. Many millennials are getting care on the run, so to speak, from retail clinics located at national drugstore chains or in urgent-care centers.

The MiMedx Group is facing serious allegations that it bilked hospitals run by the VA and the Department of Defense by limiting the sort of products that it sells to those hospitals. MiMedx makes treatments that help heal wounds, using skin grafts and injectable products from donated placental tissues. It’s a complicated case, but here’s just one thing that the company is accused of, as reported by the Wall Street Journal: “To treat the smallest wounds, MiMedx offered government hospitals nothing smaller than a 16-millimeter disk-shaped EpiFix graft costing $895. Private hospitals, however, were offered a 14-millimeter disk for $313”.

A fluid and widespread workforce might make employers take a good look at how to integrate telehealth into their health care benefit packages. Kathleen O’Driscoll, vice president for the global business group at the National Business Group on Health told Human Resource Executive that telehealth might be able to close coverage gaps. “Local plans rarely have coverage in other countries to meet the needs of the trailing dependent [the ones who do not relocate] and staying on their local home plan is not an option either,” said O’Driscoll. “Companies have been discussing how to address this gap and the potential role telehealth could play.”


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