FTC/OCR Letter Cautions Against Online Tracking Technologies + End of HIPAA Enforcement Discretion

By Center for Connected Health Policy - In a joint letter, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) and the Federal Trade Commission (FTC) have issued a stark warning to healthcare providers about the potential privacy and security hazards posed by online tracking technologies. The letter emphasizes the impermissible disclosure of consumers' sensitive personal health information to third parties. Recent investigations, media coverage, and actions taken by the FTC have brought attention to the potential hazards linked with tracking technologies, including but not limited to the Meta/Facebook pixel and Google Analytics. These tools collect identifiable information about users as they interact with websites or mobile apps, often unbeknownst to users themselves. The unauthorized sharing of personal health information can lead to severe consequences for individuals, including the exposure of sensitive health conditions, diagnoses, medications, and medical treatments. Such breaches may also pave the way for identity theft, financial loss, discrimination, stigma, mental anguish, and potential harm to an individual's reputation, health, or physical safety.

The letter emphasizes that healthcare providers who are considered covered entities or business associates under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) must adhere to the HIPAA Privacy, Security, and Breach Notification Rules. This means that if tracking technologies involve the transmission or maintenance of protected health information (PHI), they must not result in impermissible disclosures of PHI to third parties or any other violations of the HIPAA Rules. Even for entities not covered by HIPAA, the FTC Act and the FTC Health Breach Notification Rule require safeguarding against the unauthorized disclosure of personal health information. This obligation stands regardless of whether a third party developed the website or mobile app or if the information collected via tracking technologies is used for marketing purposes.

The letter also strongly urges healthcare providers to review the laws mentioned in the letter and take appropriate measures to protect individuals' health information privacy and security. Providers should also be aware that during the COVID-19 PHE, OCR exercised enforcement discretion with respect to imposing penalties for violations of HIPAA rules for providers using telehealth technologies. In April, OCR announced through a federal register notice a 90-day transition period for providers to come into full compliance with HIPAA. The 90-day transition period will end tomorrow, Aug. 9. Therefore, providers should ensure the technologies they are now using comply with all of HIPAA’s requirements. OCR has previously released a guidance document on remote communication technology that can be helpful for providers navigate the requirements.

To see the FTC and OCR’s entire warning, read the full letter issued to providers. 

Cigna’s Q2 earnings put Wall Street on edge despite huge PBM business revenues

By Wendell Potter - Purge alert! If Cigna is your health insurer and you run or work for a small business–or buy your coverage through the Affordable Care Act (Obamacare) marketplaces–get ready to give Cigna a lot more of your money next year. An average of about 23% more. And that’s just the average. You’d think Cigna was trying to run you off. And you’d have good reason to think that. Read Full Article…

VBA Article Summary

1. Cigna's Insurance Purging:

   Historical Perspective - According to an excerpt from the book "Deadly Spin," insurance companies, including Cigna, have historically used a tactic known as "purging." This involves intentionally increasing premiums for small businesses, especially those where an employee might have had a costly medical condition. The consequent high premiums often compel these businesses to discontinue insurance coverage, leaving employees uninsured.

   Current Trend - As of 2023, insurance companies are indicating significant rate increases for the upcoming year, with Cigna proposing the highest hikes: 23.6% in the individual market and 22.9% in the small group market. This surpasses the industry average premium increases, which are 9.7% and 10.7% respectively.

2. Wall Street Reaction to Cigna’s Earnings:

   Medical Loss Ratio (MLR) - The MLR represents the percentage of revenue insurers spend on medical care. A higher MLR indicates the insurance company is paying out more in claims. While Cigna’s Q2 2023 MLR increased slightly from the previous year (from 80.7% to 81.2%), it triggered a negative response from investors, leading to a nearly 4% decline in Cigna's stock price.

   Overall Performance - Despite a 7% rise in total revenues for Q2 2023, reaching $48.6 billion, Cigna's profits dropped to $1.8 billion from the previous year’s $2 billion, causing further unease among investors.

3. Consequences for Policyholders and Ethical Concerns:

   Avoiding Future Disappointments - To appease Wall Street and boost profits, Cigna plans to raise its premiums substantially in 2024. Such a move could lead many of its customers to seek more affordable alternatives or even forego insurance coverage entirely.

   Denying Claims & Legal Backlash - Efforts to improve their MLR may involve declining claims through methods like increased use of prior authorization or heightened cost-sharing obligations. Such tactics might leave policyholders shouldering more out-of-pocket expenses or having medical treatments denied. Cigna's reported instant claim rejection system, which allegedly bypasses patient file evaluation, has led to a class-action lawsuit in California.

   Financial Priorities - In the first half of 2023, Cigna invested $1.1 billion in buying back its own stock, enhancing value for investors, rather than alleviating the financial burdens of its customers through reduced premiums or out-of-pocket costs.

New “junk insurance” regs could end some voluntary benefits plans, industry insiders say

By Scott Wooldridge - A Biden Administration initiative to regulate “junk insurance” will have an impact on the brokerage industry and employee benefits, as some popular voluntary benefit programs are covered by the language of the proposed changes. However, industry insiders say there is a long way to go before the regulations are finalized, and that they hope to make the case that the regulations should be adjusted to prevent doing more harm than good. Read Full Article… 

VBA Article Summary

1. Cracking Down on "Junk Insurance": The Biden Administration announced a change in regulations targeting "junk insurance", specifically short-term health insurance plans. Previously, under the Affordable Care Act (ACA), such plans were limited to three months, but this was extended to three years during the Trump Administration. The Biden Administration now seeks to revert this change. These short-term plans have been criticized because they can exclude coverage for pre-existing conditions, leading to significant out-of-pocket expenses for those who believed they were covered. Biden described them as scams that need to end. The new regulations also affect “fixed indemnity” plans, potentially altering the voluntary benefits market. Proposed rules suggest that it would be impermissible to offer certain combinations of plans, leading to tax implications and changes in offerings.

2. Impact on Industries: Jennifer Berman from MZQ Consulting highlighted the significant effect the new rules might have on industries like retail and hospitality. These sectors often pair MEC (minimally essential coverage) plans with hospital insurance plans, a practice which would no longer be permissible under the new regulations. Janet Trautwein from the National Association of Benefits and Insurance Professionals (NABIP) points out that these voluntary benefits have evolved to provide a health care solution for workers who might not afford a traditional health plan, and also to help companies avoid ACA penalties. These solutions are not necessarily too "cheap out", but rather to address the high costs of healthcare in the U.S.

3. Regulatory Changes Ongoing: Both Trautwein and Berman emphasize that the recent announcement is just the beginning of a lengthy regulatory change process. While there may be potential compromises, such as a six-month limit on short-term insurance, the full extent of the changes is yet to be understood. The industry anticipates several adjustments between now and the proposed implementation in 2027, and stakeholders are gearing up to provide feedback during the upcoming comment period.

5 takeaways from health insurers’ second-quarter earnings

By Rebecca Pifer - UnitedHealth, CVS, Elevance and others sidestepped the worst of medical cost growth in the quarter. Major health insurers saw their shares dip coming into the second quarter, as investors prepared themselves for skyrocketing medical costs due to seniors returning for outpatient care. But health insurers generally outperformed market expectations in the quarter, helped by cost control measures. Read Full Article… 

VBA Article Summary

1. Shifts in Medical Cost Forecasts and Realities: Earlier fears regarding rising outpatient utilization among seniors didn't pan out as anticipated. Although many health insurers saw a rise in their medical loss ratios (MLRs), these increases were below what analysts had projected. Various insurers pinpointed different reasons for changing medical costs. For instance, UnitedHealth, Cigna, and CVS linked it to a surge in outpatient services like orthopedic and cardiac procedures, while Molina and Centene attributed it to preventive and primary care visits. Concerns still persist for 2023, with companies like CVS and Humana indicating that their MLRs for 2023 might touch the upper limit of their forecasts.

2. Rate Adjustments and Medicaid Redeterminations: Health insurers are factoring in the increased care activity into their 2024 Medicare Advantage bids. Payers like CVS and Cigna have taken into account the projected rise in healthcare utilization and increased costs of medical care and drugs when setting premiums for the upcoming year. With the process of Medicaid redeterminations, there's an inherent volatility. Centene, Elevance, and Molina have already witnessed a drop in their Medicaid enrollments in the second quarter. The reasons for these losses are primarily administrative, especially in states that are pushing for swift redeterminations.

3. Quality Ratings and the Impact of GLP-1 Drugs: Medicare Advantage (MA) star ratings, which measure the quality of plans and member satisfaction, have seen a drop for certain insurers. Both Centene and CVS have seen a decline in their percentage of lives in plans with higher star ratings. However, companies are actively seeking ways to improve these ratings, as they are directly tied to bonuses. The increasing popularity of GLP-1 drugs for weight control is influencing the healthcare sector in multiple ways. Although some health insurers are limiting the coverage of these drugs to control healthcare costs, those that own pharmacy businesses are benefiting from the rising demand for GLP-1 drugs, such as Novo Nordisk’s Wegovy and Ozempic. This trend is positively impacting the revenues of the pharmacy arms of these insurers.

Women over 70 risk breast cancer overdiagnosis with screening, US study finds

By Elissa Welle - A new study is raising fresh questions about the value of breast cancer screening in older women, finding that those 70 and older who underwent mammograms were more apt to be diagnosed with tumors posing no threat to their health than those who did not screen. Read Full Article… 

VBA Article Summary

1. Increasing Age and Overdiagnosis: The study, which tracked 54,635 U.S. women aged 70 and older who received mammograms in 2002, discovered a trend of increasing overdiagnosis with age. Specifically, up to 31% of breast cancer cases among women ages 70 to 74 were overdiagnosed. This percentage surged to 47% for those aged 74 to 84, and further to 54% for women 85 and older. Overdiagnosis is described as detecting a medical condition via screening that wouldn't have manifested any symptoms or complications within a person's lifespan. This can lead to unnecessary treatments and related emotional and financial strains.

2. Lack of Significant Impact on Mortality: Interestingly, the study did not establish any statistically significant reductions in breast cancer-related deaths linked with the mammogram screenings. This highlights a potential limitation in the efficacy of continued screenings, especially as age advances.

3. Contrasting Screening Recommendations: Medical organizations offer varied recommendations concerning mammograms for older women. For instance, the U.S. Preventive Services Task Force advises mammograms every two years for women aged 50 to 74 but is uncertain about the screenings' value for those aged 75 and above. Meanwhile, the American Cancer Society recommends mammograms for women over 55 if they are expected to live for over 10 more years. The American College of Physicians, on the other hand, suggests stopping the screening for women over 74 if their life expectancy is a decade or less. Dr. Ilana Richman emphasized the need for older women to grasp the complete scope of risks and benefits associated with mammograms. Furthermore, experts from Johns Hopkins University suggest the necessity for new tools to better discern the stage and seriousness of detected cancers.

Only 1 in 5 people with opioid addiction get the medications to treat it, study finds

By Brian Mann - Imagine if during a deadly public health crisis, 80% of Americans weren't able to get safe, effective medications proven to help people recover. A study published Monday in the JAMA found that's exactly what's happening with the opioid crisis. Nationwide, only one in five people with opioid use disorder receive the medications considered the gold standard for opioid treatment, such as methadone, buprenorphine or extended-release naltrexone. Read Full Article… 

VBA Article Summary

1. Underutilization of Lifesaving Medications: Despite compelling evidence showcasing their safety and effectiveness, certain medications like methadone and buprenorphine are rarely prescribed to patients with opioid addiction. For instance, a 2018 study showed that methadone reduced overdose death rates by 59%, and buprenorphine by 38%. However, these drugs are significantly underused, especially among vulnerable groups such as women, Black adults, unemployed Americans, and those residing in urban areas. This reluctance to prescribe is linked to the stigma around addiction and lack of training among medical professionals.

2. Opioid Crisis and the Role of Telehealth: Opioid overdose deaths reached unprecedented levels in the US, with over 80,000 deaths in 2021 and almost 83,000 in 2022. Amidst this crisis, recent studies have shed light on the potential role of telehealth in addressing the issue. Patients with opioid addiction who sought medical assistance via telehealth were approximately 38 times more likely to be prescribed the necessary medications. This data supports the increasing evidence suggesting that telehealth services could be instrumental in bridging the gap between available treatments and those in need, potentially preventing numerous opioid-related overdoses.

3. Addressing Inequities in Treatment: The medical community is being urged to confront and rectify the disparities in treatment approaches for people with addiction. These inequalities are potentially contributing to the elevated rates of overdose deaths. Collaboration between institutions like the National Institute on Drug Abuse, the Food and Drug Administration, and the Centers for Disease Control and Prevention emphasizes the need for evidence-based care and equal access to treatments for all, ensuring that safe and effective medications aren't left "sitting on the shelf unused."

State and local governments are acting to unburden millions in medical debt but federal action is still needed

By Eva Stahl - Every week at RIP Medical Debt, we hear stories from our beneficiaries about the harm of medical debt and their inability to make ends meet. The stories are thematically similar – stress, limited resources and fear of accessing healthcare. Read Full Article… 

VBA Article Summary

1. Medical Debt Crisis Despite Insurance: Despite 92% of U.S. residents having insurance in 2022, out-of-pocket healthcare costs continue to burden individuals and families. Medical debt doesn't only affect the uninsured; even insured individuals face financial hardships due to high deductibles and other cost-sharing requirements. For instance, Camille's experience highlights the struggles faced by many, where a debt that might seem small can have significant negative repercussions on one's financial well-being. The article emphasizes that having insurance doesn't always equate to being protected from accumulating medical debt, especially with high-deductible plans. This is further supported by research findings, such as the study by David Himmelstein and colleagues, which elucidates the nuances and complexities of the medical debt problem, shedding light on the connections between medical debt, mental health implications, and the potential for increased risks of food and housing insecurity.

2. RIP Medical Debt’s Role and Solutions: RIP Medical Debt offers a proactive approach to alleviating the weight of medical debt by purchasing and abolishing it with donated funds. Over the past year, many local governments have approached RIP Medical Debt to help their residents escape the clutches of this financial burden. The organization’s strategy revolves around purchasing medical debt from both the debt market and directly from hospitals and providers. With their grassroots fundraising efforts, they leverage every dollar donated to abolish, on average, $100 of medical debt. This initiative not only provides immediate relief to countless individuals but also sends a broader message about the tangible impacts of medical debt on communities and the significance of addressing its root causes.

3. Governmental Responses and Actions: Recognizing the magnitude of the medical debt crisis and its implications on constituents, numerous local governments and states have stepped up, implementing strategies to reduce or eliminate medical debt. For instance, Cook County in Illinois, Toledo and Lucas County in Ohio, and New Orleans in Louisiana have undertaken measures to combat the crisis, utilizing funds like the American Relief Plan Act (ARPA) to purchase and abolish debt. Furthermore, some states, like New Jersey and Connecticut, have incorporated medical debt abolishment in their budgets. The article also emphasizes the importance of not only expanding health insurance access but ensuring these expansions protect people from accruing medical debt. The broader goal remains: making healthcare truly affordable for everyone.

CMS proposes $375M cut to home health Medicare payments in 2024

By Heather Landi - The Biden administration issued a proposal Friday to cut reimbursements to home health providers by 2.2% next year, or an estimated $375 million less than 2023 payment levels. The Centers for Medicare & Medicaid Services (CMS) released Friday a proposed rule outlining changes to the 2024 Home Health Prospective Payment System and updating rates for home health agencies. Read Full Article… 

VBA Article Summary

1. Proposed Payment Adjustments for 2024: The Centers for Medicare & Medicaid Services (CMS) has proposed a 2.7% increase ($460 million) in payments for home health agencies for the fiscal year 2024. This is countered by a 5.1% reduction, reflecting the effects of the permanent behavior assumption adjustment, translating to a decrease of $870 million. The changes also include an estimated 0.2% increase ($35 million) due to the updated fixed-dollar loss ratio. The modifications come in light of the implementation of the Patient-Driven Groupings Model (PDGM) and the change from a 60-day to a 30-day unit of payment, as mandated by the Bipartisan Budget Act of 2018.

2. Concerns from Home Health Industry: Industry groups have criticized the proposed payment changes, with concerns about the methodology CMS uses. Evidence suggests reduced access to home health services due to past cuts. The Partnership for Quality Home Healthcare warned that the proposed actions for 2024 could degrade beneficiary access to home healthcare services. They estimate that cuts will amount to over $18 billion over the next ten years, affecting the hiring and availability of skilled healthcare professionals.

3. Legislative Interventions: Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) introduced the "Preserving Access to Home Health Act of 2023" aimed at preventing further cuts to home health providers. This bill, if passed, would limit CMS's authority to set payment rates and would require the Medicare Payment Advisory Commission (MedPAC) to consider Medicare Advantage payment rates in its reports. There are strong calls from industry groups for Congress to support this legislation to protect the home health benefit.