Telehealth Services Safe Harbor for High-Deductible Health Plans Expires December 31, 2024

By VORYS - On December 21, 2024, President Biden signed into law the American Relief Act, 2025 (2025 Relief Act), which funds the federal government through March 14, 2025, and provides certain disaster relief provisions and other economic assistance.  However, many important health-related provisions that may impact health plans were stripped from the 2025 Relief Act at the last minute.  Read Full Article… 

HVBA Article Summary

1. Expiration of Telehealth Safe Harbor: The telehealth safe harbor, which allowed HDHP sponsors to provide pre-deductible coverage for telehealth services, will expire on December 31, 2024. Starting January 1, 2025, participants in HDHPs may lose eligibility for HSA contributions if they access non-preventive telehealth services below fair market value before meeting the HDHP deductible.

2. Plan Sponsor Options Post-Expiration: Sponsors of HDHPs must decide how to proceed, including requiring participants to pay fair market value for telehealth services, disallowing non-preventive telehealth services until deductibles are met, or eliminating telehealth services from plans entirely. Each approach may impact participants differently and necessitates careful consideration.

3. Communication and Compliance: Sponsors need to update plan documents and communicate any changes clearly to participants. Additionally, they must evaluate whether changes to telehealth services constitute significant coverage modifications under their cafeteria plans, ensuring compliance with regulatory requirements.

Two employer health coverage reporting bills become law

By Allison Bell - President Joe Biden has signed two bills that will ease some Affordable Care Act health coverage reporting requirements for employers. One is the Paperwork Burden Reduction Act, and the other is the Employer Reporting Improvement Act bill. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Streamlining Employer Reporting: The Employer Reporting Improvement Act introduces key changes to employer reporting processes for health benefits. Employers can now provide Form 1095-B and Form 1095-C notices electronically, reducing administrative burdens. The act also permits the use of birthdates instead of Social Security numbers when the latter is unavailable and extends the time employers have to respond to IRS warnings from 30 to 90 days, while limiting IRS assessments to a six-year window.

2. Reducing Paperwork Requirements: The Paperwork Burden Reduction Act formalizes existing IRS practices by allowing employers to provide Form 1095-B only upon request, rather than to all employees. It extends this flexibility to Form 1095-C as well, further reducing administrative overhead for employers managing health benefit reporting.

3. Preparation and Uncertainty: While the two laws aim to simplify reporting, questions remain about their effective date. Blogger Jenny Gartman advises employers to consult reporting vendors or service providers to ensure compliance and adjust timelines, particularly with the potential January 31, 2025, deadline.

Navigating Virtual Prescribing Policy Changes in 2025

By Thomas R. Milam - Telehealth prescribing has reshaped behavioral healthcare delivery across the U.S., making essential medications more accessible than ever before. Recent data shows the proportion of Medicaid beneficiaries accessing buprenorphine treatment through telehealth increased year over year from 2% to over 15% in states like Kentucky and Ohio. Read Full Article…

HVBA Article Summary

1. Urgency for Permanent Regulations: The DEA's extension of virtual prescribing flexibilities through 2025 underscores the need for immediate action to establish permanent regulations. Without clear frameworks, behavioral health providers and patients face significant uncertainty, jeopardizing access to essential medications for addiction treatment and mental health.

2. Key Challenges in Virtual Prescribing: Post-pandemic, telehealth prescribing encounters critical challenges, including patient safety concerns from high-profile compliance failures, administrative burdens for providers adapting to inconsistent guidelines, and disproportionate impacts on rural and underserved communities lacking in-person care options.

3. Collaborative Solutions for Sustainability: Ensuring the future of telehealth prescribing requires a multi-stakeholder approach. Providers must enhance compliance and coordination, patients should advocate for successful outcomes, and policymakers need to craft evidence-based, balanced regulations that maintain access while prioritizing safety.

The biggest medical advances of 2024

By Matthew Herper - It’s easy to forget that we live in an age of medical wonders. Cancer tumors can be slowed or shrunk in ways previous generations couldn’t imagine, with everything from pills to genetically engineered white blood cells. Surgeons can transplant a face, or replace a heart valve without cracking a chest. These are outcomes that would not have been possible 20 years ago. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. GLP-1s Expanding Beyond Obesity: The FDA's approval of semaglutide for reducing cardiovascular risks and treating heart failure marks a significant broadening of GLP-1 analogues' therapeutic uses beyond diabetes and obesity. Alongside this, new trials highlight their potential in alleviating knee arthritis pain and treating sleep apnea with tirzepatide. With multiple companies racing to develop oral versions, these drugs are poised to become even more accessible and impactful for a wide array of conditions.

2. Advancements in HIV Prevention: Lenacapavir, a long-acting injection given biannually, demonstrated superior efficacy in preventing HIV compared to traditional daily pills like Truvada. This breakthrough not only simplifies treatment but also provides a promising tool in combating the global HIV epidemic. However, challenges in equitable access, particularly in less affluent regions, underscore the need for systemic changes in healthcare delivery.

3. Breakthroughs in Drug Approvals and Treatments: From schizophrenia to muscular dystrophy, 2024 saw the approval of 50 new medicines, including innovative treatments like Cobenfy for schizophrenia and Duvyzat for Duchenne muscular dystrophy. Additionally, incremental progress in cancer treatments, such as Enhertu’s expanded efficacy and Tagrisso's use in earlier-stage lung cancer, exemplifies how consistent innovation continues to redefine patient outcomes across a spectrum of diseases.

Virtual nursing is here, whether you like it or not

By G Hatfield - 2024 was a year for great innovation. Health systems made great strides toward implementing new technologies into workflows, including AI, robotics, and wearables. Perhaps the biggest leap forward was made in the realm of virtual care, especially in nursing. Read Full Article…

HVBA Article Summary

1. Exponential Growth of Virtual Nursing: The adoption of virtual nursing is expected to surge in the next decade, with predictions from industry leaders like Steve Klahn forecasting that 60% to 70% of nursing roles will incorporate virtual components. This expansion is driven by the positive response to virtual nursing programs, which have been increasingly implemented since the COVID-19 pandemic.

2. Transforming the Nursing Landscape: Virtual nursing is set to revolutionize the profession by enhancing care delivery and improving operational efficiency. According to Dr. Shakira Henderson, the future could see a generation of nurses who primarily or entirely work in virtual settings, redefining the traditional notion of patient interaction in nursing.

3. New Care Models and Technology Integration: The integration of virtual nursing into care models will include advanced remote monitoring technologies, task-sharing between virtual and bedside nurses, and innovative nursing team structures. These models aim to improve efficiency, reduce patient wait times, and expand care capacity through seamless collaboration between virtual and in-person roles.

UnitedHealth’s Army of Doctors Helped It Collect Billions More From Medicare

By Christopher Weaver, Anna Wilde Mathews, and Tom McGinty - Like most doctors, Nicholas Jones prefers to diagnose patients after examining them. When he worked for UnitedHealth Group, though, the company frequently prepared him a checklist of potential diagnoses before he ever laid eyes on them. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Manipulation of Diagnoses for Financial Gain: UnitedHealth's approach to recording diagnoses, particularly in its Medicare Advantage plans, has raised concerns about prioritizing financial incentives over patient care. The use of software that pressures doctors to confirm or add potentially unnecessary diagnoses can lead to inflated "sickness scores," triggering higher Medicare payments. Doctors reported feeling coerced into making diagnoses that often lacked evidence or relevance to patient care.

2. Disparities in Sickness Scores and Payments: The Wall Street Journal's analysis highlights significant disparities in sickness scores between Medicare Advantage and traditional Medicare patients, especially those treated by UnitedHealth-employed physicians. These scores rose by an average of 55% in the first year of enrollment in UnitedHealth's Medicare Advantage plans, resulting in billions in additional government payments. Critics argue that this system incentivizes upcoding and may undermine the integrity of Medicare Advantage.

3. Impact on Physician Practice and Patient Trust: Former UnitedHealth doctors and patients have voiced concerns about the system's design, which they claim detracts from genuine patient care. Physicians reported being pressured or incentivized to add diagnoses, sometimes based on minimal evidence, while patients expressed skepticism about their diagnoses, suspecting financial motivations behind their doctors’ decisions. These practices risk eroding trust in the healthcare system and the Medicare Advantage program.

Dr. Eric Topol: Generative AI Studies Boast Promising Results, But Real-World Challenges Remain

By Katie Adams - Cardiologist and researcher Dr. Eric Topol is considered by many to be one of the leading voices contributing to the conversation around technology’s impact on healthcare. Read Full Article…

HVBA Article Summary

1. Preliminary Successes and Real-World Limitations: While generative AI shows promising results in controlled studies, including outperforming physicians and hybrid models in tasks like differential diagnosis, Dr. Topol cautions that these findings often stem from artificial, simulated environments. He emphasizes the need for more real-world testing to validate AI's performance in clinical settings.

2. Challenges with Hybrid Models and Physician Integration: Generative AI unexpectedly outperformed hybrid models due to factors like physician bias against automation and limited familiarity with these tools. Dr. Topol highlights that effective integration of AI into clinical practice will require addressing these barriers and improving physicians' understanding of AI capabilities.

3. Proven Impact in Documentation: Despite uncertainties in diagnostic applications, generative AI has demonstrated clear benefits in clinical documentation. Tools from companies like Abridge, Microsoft, Suki, and DeepScribe are already streamlining workflows, enhancing accuracy, and significantly reducing administrative burdens for physicians, signaling a bright future for AI in healthcare.

Just Minutes of Daily Vigorous Exercise Improve Heart Health

By Carolyn Brown - Middle-aged women who did many short bursts of vigorous-intensity exercise — amounting to as little as 3 min/d — had a 45% lower risk for major adverse cardiovascular events, reported investigators. Read Full Article…

HVBA Article Summary

1. Vigorous Intermittent Lifestyle Physical Activity: High-intensity movements lasting 20–30 seconds, repeated throughout the day, can significantly improve cardiovascular health. Examples include climbing stairs or running for a bus. These bursts of energy, as short as a minute, challenge the cardiovascular system and promote physiological adaptation.

2. Gender-Specific Findings: The study observed a stronger correlation between vigorous physical activity and cardiovascular benefits in women than in men, with women experiencing a direct relationship between exercise time and risk reduction. Men showed subtler effects, suggesting potential differences in intensity thresholds or physiological responses.

3. Accessibility and Everyday Integration: This form of exercise requires no gym memberships, special gear, or structured schedules, making it accessible to all. Researchers emphasize that small lifestyle adjustments, such as incorporating brief high-intensity activities into daily routines, can yield significant health benefits.