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The Future of Healthcare Could Be a Privacy Nightmare

TONIC - Susan Rinkunas -Feb 8 2018, 10:54am The Amazon healthcare effort and CVS-Aetna merger raise lots of questions. Last Tuesday, Amazon, JP Morgan, and Berkshire Hathaway announced that they were coming together to do…something related to healthcare for their 1.2 million employees and could possibly expand to the public. We don’t know whether they’ll provide health insurance, offer health clinics at company buildings and/or Whole Foods stores, or just use their size to negotiate better prices with existing insurance companies. Despite the fact that we have next to zero information about what AmazonCare would actually be, the news still sent healthcare stocks falling and led to optimistic predictions and double-takes from doubters. And it has been freaking me out for the past week. Why? Millions of Americans are hooked on Amazon and its two-day shipping. We use it to order toiletries and home supplies, watch movies, and even get our groceries delivered. The site recommends products to you based on your order history. If the parent company is somehow involved in healthcare, it’s not that hard to imagine a world in which Amazon would use people’s health data to suggest products—or even actively try to stop people from buying “unhealthy” things.Is that imagined scenario something that could actually happen or more Black Mirror territory? I talked to a few privacy and health law experts about Amazon—as well as CVS, since CVS pharmacy and health insurer Aetna announced plans to merge in December. While that deal is still pending, it’s also a privacy minefield of healthcare-meets-retail. Initially, they made me freak out even more, but they also reminded me that there are still a lot of unknowns. I asked Frederik Zuiderveen Borgesius, a privacy researcher [...]

Tax on medical devices to resume after 2-year suspension

CNBC via AP- JANUARY 1ST, 2018 While much of corporate America will enjoy a tax cut in the new year, one industry is getting a tax increase it has fought hard but so far unsuccessfully to avoid. A 2.3-percent excise tax on medical device manufacturers is set for reinstatement Monday after a two-year hiatus. It was originally imposed in 2013 as one of several taxes and fees in the Affordable Care Act that pay for expanded health insurance under the law The tax was strongly opposed by the $150 billion a year industry that produces everything from catheters to heart stents to artificial joints. In Congress, it was unpopular not only with Republicans but many Democrats from states like Massachusetts and Minnesota with large numbers of medical device companies. Congress voted to suspend the tax for 2016 and 2017 with the widespread expectation it would be permanently abolished before 2018. But various GOP efforts to repeal the Affordable Care Act and the taxes associated with it failed, and the sweeping federal tax overhaul recently signed by President Donald Trump didn't eliminate the medical device tax either. Industry groups Including the Advanced Medical Technology Association (AdvaMed) and the Medical Imaging & Technology Alliance warn the tax will take a $20 billion bite out of the industry over the next decade. "What we have seen from past experience is that it comes out of funding for product development, research and the jobs associated with those things," said J.C. Scott, AdvaMed's head of government affairs. "We fear we will see employment freezes or reductions and a slowdown in the pipeline for medical innovation." The slashing of the overall corporate tax from 35 percent to 21 percent may soften [...]

How the New U.S. Tax Plan Will Affect Health Care

Harvard Business Review: David Blumenthal- December 19, 2017 The new Republican tax bill, which the House passed this afternoon and the Senate is expected to approve tonight, is complex, but what it will mean for health in the United States is simple: less. It will mean less health insurance for individuals; less coverage for elderly and poor Americans; less revenue for doctors, hospitals, and myriad health care businesses; and, quite possibly, a less-healthy, less-productive workforce. The tax bill will be the most important health care legislation enacted since the Affordable Care Act (ACA) in 2010. The law’s two major health-related aspects are the elimination of the penalties paid by people who fail to have health insurance as required by the so-called individual mandate, and the bill’s overall impact on the federal deficit — which will increase by an estimated $1.45 trillion after allowing for predicted economic growth. According to the Congressional Budget Office (CBO), the repeal of the individual mandate penalties could result in as many as 13 million fewer Americans having health insurance. About 5 million are projected to be people who previously bought health insurance as individuals either within or outside the ACA’s marketplaces. Some will choose not to buy insurance because the penalty has disappeared. Others, especially higher-income individuals who don’t qualify for subsidies under the ACA, will drop insurance because of increases in average premiums predicted by the CBO. These premium increases will occur because, with the repeal of the mandate, many young, healthy people will exit markets, leaving a sicker, more costly insurance pool behind. Older individuals will be most affected. For example, a 60-year-old not receiving subsidies could face premium increases of $1,781, $1,469, $1,371, and $1,504, respectively, in Alaska, [...]

UnitedHealth’s Splish Beats CVS-Aetna’s Splash

Bloomberg Gadfly - By Brooke Sutherland Max Nisen - Dec 6, 2017 11:52 AM EST UnitedHealth Group Inc. is that kid in school who's always doing better than you.The $214 billion company announced on Wednesday that it's buying DaVita Inc.'s physician-network business for $4.9 billion. It's just the latest step in UnitedHealth's push to diversify its revenue. Thanks to deals over the past few years, the company isn't just the largest private U.S. health insurer, it's also a pharmacy-benefit manager, a health care analytics company and increasingly a provider of medical care through physician clinics, outpatient services and urgent care centers. *The company's two largest insurer purchases -- of units of Fiserv and Sierra Health Services -- were both announced in 2007 and included a number of non-insurance businesses that likely now fall under Optum This is the blueprint that CVS Health Corp. and Aetna Inc. are attempting to follow with their $77 billion merger. Antitrust authorities have made abundantly clear that they aren't fans of further consolidation among the top health insurers nor among the top drug-store operators, forcing companies to look elsewhere in the health-care world for growth opportunities. UnitedHealth has proven that diversification does more than just create new revenue streams -- it also offers cost, information, and convenience advantages that can in turn bolster the appeal and performance of the insurance unit. The problem for CVS-Aetna is that UnitedHealth had the idea first, and the DaVita deal is a reminder that it has no intention of slowing down. UnitedHealth is a much larger provider of medical services than many people realize, and deals like the DaVita acquisition and its $3.2 billion purchase of outpatient-services provider Surgical Care Affiliates Inc. earlier this year have [...]

On children’s health coverage, congressional inaction has brought us to the ‘nightmare scenario’

LA TIMES - Micahel Hiltzik- November 27, 2017 Child healthcare advocates have been warning, and warning, and warning that Congress’ delay on reauthorizing funds for the Children’s Health Insurance Program places health coverage for as many as 9 million children and pregnant women at risk. But since the funding expired Sept. 30, there has been no action by Congress. Now, advocates say, “the nightmare scenario is close” for states across the country, to quote former Medicare and Medicaid chief Andrew Slavitt, as the state-federal program runs out of federal money. State officials in Colorado started sending letters to families on CHIP as early as Monday, warning them that their kids’ health insurance could run out Jan. 30 and they should “start researching private health insurance options.” If Congress doesn’t vote within two weeks to resume the program’s $15 billion in annual funding, the state officials said, they would send out official notification of the program’s cancellation. A similar high-wire act is playing out in at least 11 states whose CHIP coffers will be exhausted by the end of December, according to the Kaiser Family Foundation; that roster includes California. In Colorado and 20 others, there’s just enough money left from earlier appropriations to last into the first month or so of 2018. We’ve sounded the alarm about the expiration of CHIP in four columns since May, when congressional dysfunction built to the point that a reauthorization of CHIP by Sept. 30 began to look doubtful. The fears of children’s advocates proved true when the deadline passed without a vote; but even then most assumed that the delay would be brief, and the issue would be resolved before too many states had to take stringent measures. [...]

By |December 1st, 2017|Blog, Commercial Insurance, Credentialing, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, medicare claims, Obamacare, Physician Credentialing|Comments Off on On children’s health coverage, congressional inaction has brought us to the ‘nightmare scenario’

Amazon’s cloud is about to announce a huge health-care deal with Cerner

CNBC- Christina Farr | Jordan Novet Published 11:21 AM ET Wed, 22 Nov 2017 Updated 1:22 PM ET Wed, 22 Nov 2017 Amazon's cloud unit to partner with Cerner: Sources Amazon's cloud unit to partner with Cerner: Sources say Amazon's cloud business, in its march toward $20 billion in annual revenue, has nabbed top clients in areas ranging from energy and technology to financial services and government. Heading into its annual re:Invent conference in Las Vegas next week, Amazon Web Services has found a partner to help the company crack a massive industry that's been slower to adopt the cloud: health care. As part of his keynote at re:Invent, AWS CEO Andy Jassy is planning to announce that Amazon is teaming up with Cerner, one of the world's largest health technology companies, to help health-care providers better use their data to make health predictions about patient populations, according to sources familiar with the matter. The sources, who asked not to be named because the discussions are still in the final stages, said the partnership is initially focused on Cerner's so-called population health product — HealtheIntent — which enables hospitals to gather and analyze huge volumes of clinical data to improve patients' health outcomes and lower treatment costs. Cerner did not provide a comment for this story, and AWS representatives didn't respond to requests for comment. In addition to its health investments, AWS has sought to expand its push into the public sector. Earlier this week it announced plans for a group of cloud data centers for the CIA and other U.S. intelligence community members. Relative to most industries, hospitals and other health providers have resisted the shift from traditional data centers to the cloud because of [...]

Insurers make billions off Medicaid in California during Obamacare expansion

Los Angeles Times - Chad Terhune and Anna Gorman- NOVEMBER 6, 2017 Medicaid is rarely associated with getting rich. The patients are poor, the budgets tight and payments to doctors often paltry. But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds that patient care is subpar. Health Net, a unit of Centene Corp., the largest Medicaid insurer nationwide, raked in $1.1 billion in profit from 2014 to 2016, according to state data obtained by Kaiser Health News. Anthem, another industry giant, turned a profit of $549 million from California’s Medicaid program in the same period. Overall, Medicaid insurers in the Golden State made $5.4 billion in profits from 2014 to 2016, in part because the state paid higher rates during the inaugural years of the nation’s Medicaid expansion under the Affordable Care Act, or Obamacare. Last year, they made more money than all Medicaid insurers combined in 34 other states with managed care plans. “Those profits are gigantic — wow,” said Glenn Melnick, a health economist and professor at USC. Alan Sager, a health-policy professor at Boston University, was surprised — and dismayed. “California is being wildly open handed and excessively generous with insurers,” he said. Jennifer Kent, California’s Medicaid director, said that health plan profits were higher than anticipated during the ACA expansion. But she said the state expects to recoup a significant amount of money within the next year once audits are complete and other retroactive rate adjustments are made. “We’re going to be taking a lot of money back. We’re talking billions of dollars,” Kent said in an interview Friday. No one should think “these plans just made off like bandits and [...]

By |November 9th, 2017|Blog, Commercial Insurance, Credentialing, doctor, doctor Credentialing, Healthcare Professionals, Medicaid, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on Insurers make billions off Medicaid in California during Obamacare expansion

If Republicans Revive Health Care Again, This Is What It Could Mean For Your State

NPR- September 22, 20173:19 PM ET -Danielle Kurtzleben John McCain on Friday imperiled Republicans' latest Affordable Care Act repeal and replace effort when he said he "cannot in good conscience" support the so-called Graham-Cassidy bill. But McCain did also say he could at some point support the substance of his fellow Republicans' proposal. "I would consider supporting legislation similar to that offered by my friends Sens. [Lindsey] Graham and [Bill] Cassidy were it the product of extensive hearings, debate and amendment," McCain said. "But that has not been the case." That's notable because for the first time since Trump became president, there actually seemed to be some real ideological unity around a repeal-and-replace effort from Republicans. Graham-Cassidy Health Bill Would Shift Funds From States That Expanded Medicaid If it is revived — and this effort isn't quite dead yet, because other GOP holdouts haven't stated their unequivocal opposition publicly — the Graham-Cassidy bill very well may be the foundation of how the health care system is reshaped. What would it mean for where you live? We take a look A big selling point of Graham-Cassidy, according to its proponents, is flexibility for states. In place of the federal dollars that fund Obamacare's subsidies and Medicaid expansion, Graham-Cassidy, which under the latest GOP proposal would be law in 2020, would give states block grants. Those are big chunks of money given directly to states, which would have broad discretion in how to spend them. But what's important is that those block grants would be less money than the total money that states are getting for Obamacare right now. Graham-Cassidy would eliminate the premiums that help people pay for their health insurance and the payments helping insurance companies [...]

By |September 23rd, 2017|Blog, Doctor, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Optometrist, Physician Credentialing|Comments Off on If Republicans Revive Health Care Again, This Is What It Could Mean For Your State

Medicare for All or State Control: Health Care Plans Go to Extremes

NY Times - By ROBERT PEAR- SEPT. 13, 2017 WASHINGTON — In one Senate office building, some of the leading lights of the Democratic Party gathered Wednesday to embrace what was once a proposal only of the far left: a huge expansion of Medicare, large enough to open the popular, government-run health program to all Americans. In another Senate office building, a smaller but equally adamant group of Republican senators stood together to take one last stab at dismantling the Affordable Care Act. They proposed instead to send each state a lump sum of federal money, along with sweeping new discretion over how to use it. Important elements in both parties are trying to move beyond President Barack Obama’s health care law, which has always been a complicated, politically difficult mix of government and private health insurance. But they are moving in radically different directions. The proposals appeared to have only one thing in common: Neither is likely to be enacted any time soon. Senator Bernie Sanders of Vermont, the onetime candidate for the Democratic presidential nomination, proposed what he called “a Medicare-for-all, single-payer health care system,” and he said 16 Democratic senators supported it. Those included Elizabeth Warren of Massachusetts, Cory Booker of New Jersey, Kirsten E. Gillibrand of New York and Kamala Harris of California — all names on the list of possible candidates for president in 2020. “Instead of wasting hundreds of billions of dollars trying to administer an enormously complicated system of hundreds of separate insurance plans, there would be one insurance plan for the American people with one single payer,” said Mr. Sanders, the ringmaster of an event that felt like a political rally, with banners and placards, consumers and patients, [...]

States hurry to fix health-insurance markets

The Economist- Aug 31st 2017 | WASHINGTON, DC Though insurers remain, Obamacare is teetering in places NOT long ago, America’s health-insurance markets seemed to be drying up. In June 49 counties lacked any willing providers for the “individual market”, which serves 18m Americans who are not covered by an employer or the government. The Affordable Care Act, Barack Obama’s health-care law, seemed to have failed these places. Frantic efforts by state officials have filled the gaps: Nevada’s governor claims to have interrupted a hiking trip with his daughter to broker a deal covering most of his state. The last empty market, in Ohio, gained an insurer on August 24th. But failure has not yet been averted. With health reform stalled in Congress, several states are rushing to patch things up themselves before insurance for 2018 goes on sale in November. Obamacare’s markets were always likely to limp on rather than collapse utterly, because they have a blank cheque from the federal government. The law caps premiums for buyers who earn less than four times the poverty line (this year the cut-off is $48,240 for an individual). No matter how high premiums rise and how many healthy people leave the market, some subsidised enrollees, who have already reached their premium caps, will keep buying. The only surprise is that it has taken so much cajoling to get insurers to run monopolies in markets buttressed by such generous government support. Yet rising premiums are a big problem for many of the 9m Americans who buy insurance for themselves without any government help. In Iowa about 28,000 people are on the hook, according to Doug Ommen, the state’s insurance commissioner. As things stand, only one firm, Medica, will sell [...]