Frustration over surprise billing implementation builds in House hearing

By Susanna Vogel - Lawmakers are expressing bipartisan frustration over the implementation of the No Surprises Act, a law meant to protect patients from unexpected medical bills after receiving care from out-of-network providers at in-network facilities. In a House Ways and Means Committee hearing on Tuesday, Representatives grilled witnesses including payers, providers and arbitration services representatives about the implementation of the NSA, which went into effect in January 2022. Read Full Article…

VBA Article Summary

1. Inadequate Implementation and Contentious Relations: Despite being intended to provide a solution for surprise medical bills, the implementation of the independent dispute resolution (IDR) process within the NSA has faced significant criticism from both sides of the aisle. Rep. Richard Neal, the law's author, labeled its implementation as a "disappointment," while Chairman Jason Smith stated that the law had worsened the problem it was meant to solve. The process is said to have created a rift between medical providers and payers, even resulting in legal challenges that have led to procedural backlogs.

2. Disproportionate Impact on Providers and Rural Healthcare: Medical providers argue that the IDR process is flawed and inefficient, benefiting health insurers at the expense of healthcare providers. This situation is particularly concerning for rural facilities that are already facing financial constraints. The inefficiencies in the IDR process, evidenced by data indicating that only a small percentage of claims reach a payment determination, mean that timely, fair, and equitable determinations are rare. Providers claim that resolving these issues could significantly improve the quality of patient care, especially in rural areas.

3. Proposed Solutions and Future Directions: While the dispute continues, there are calls for improvement from both providers and payers. Providers advocate for more arbitrators and stronger enforcement mechanisms. Payers, on the other hand, call for technological investments to increase transparency into the claims process. James Bobeck, president of Federal Hearings & Appeals Services, emphasizes that many problems arose from "misunderstanding, miscommunication, and misinformation," suggesting that automation and better information exchange can streamline the process moving forward.

Physicians rush to get certified in obesity medicine

By Erica Carbajal - Nearly 1,900 U.S. physicians have applied to become certified in obesity medicine — a record number — according to data from the American Board of Obesity Medicine. In October, 1,889 physicians will take the exam to become certified in the specialty area. That's up from 1,001 exam candidates in 2020, marking an 88.7 percent jump. Read Full Article…

VBA Article Summary

1. Booming Demand for Obesity Treatments: The skyrocketing sales figures for GLP-1 receptor agonist drugs like Ozempic and Wegovy, which reached $3 billion in the U.S. as of August 2023, indicate a growing patient demand for effective obesity treatments. This surge is reflected in the increasing interest among physicians in becoming certified in obesity medicine.

2. Surge in Obesity Medicine Certification: Since its inception in 2012, more than 6,700 physicians have gained certification in obesity medicine. With the upcoming exam in October, 38% of the candidates are from internal medicine, and 30% are from family medicine. To qualify for the exam, physicians are required to complete at least 60 continuing medical education credits focused on obesity, underscoring the specialty's rigorous standards.

3. Addressing a Gap in Medical Training: According to Judith Korner, MD, PhD, board chair of the American Board of Obesity Medicine (ABOM), many physicians seek certification to fill a knowledge gap in treating obesity, a topic often insufficiently covered in their prior medical training. The ABOM, founded in 2011, plays a critical role in equipping doctors with the skills needed to treat obesity as a complex chronic disease, thereby aligning with evolving treatment options and standards of care.

EEOC lawsuits against Walmart mount amid allegations they violated Americans with Disabilities Act

By Kristen Parisi - Since the Americans with Disabilities Act (ADA) was passed in 1990, employers have been required to provide reasonable accommodations to disabled job applicants and employees. However, in 2022 alone, there were 25,004 alleged ADA violations. In the last few weeks, the Equal Employment Opportunity Commission (EEOC) filed two lawsuits alleging ADA violations against the nation’s largest private employer, Walmart. Read Full Article…

VBA Article Summary

1. Lack of Accommodations for Deaf Employees: The first lawsuit centers on a Walmart store in Kansas, where it is alleged that the company failed to provide essential accommodations, such as ASL interpreters during training and effective written communication for its deaf employees. This led both employees to quit, highlighting the urgent need for companies to adhere to ADA guidelines. As pointed out by Andrea G. Baran, regional attorney at the EEOC St Louis District, not only are such accommodations mandated by law, but they also contribute positively to businesses and society at large.

2. Discriminatory "Knowledge Assessment" Test: A second lawsuit filed against Walmart claimed that two disabled employees—an individual who is deaf and another with cognitive disabilities—were fired after failing a "knowledge assessment" test, which was not directly related to their job functions. Despite Walmart's assertion that the testing program had been discontinued, the lawsuit suggests systemic issues related to discriminatory practices against disabled employees.

3. A History of ADA Violations: Walmart has faced multiple lawsuits related to ADA violations over the last 15 months, filed by the EEOC. In 2021, the retail giant was initially ordered to pay $125 million to a former employee with Down syndrome who was terminated because of her disability. Although the amount was later reduced to $300,000, it emphasizes a pattern of issues regarding ADA compliance. Despite Walmart's claims of being a top employer for those with disabilities, the recent spate of lawsuits raises questions about the company's commitment to upholding federal laws designed to protect disabled employees.

Hospitals' Price Transparency Efforts Need To Also Focus On Consistency

By Jay Asser - Providing pricing information is just one aspect of improving price transparency—undermined by giving patients inaccurate or inconsistent prices. To achieve greater price transparency and build trust with patients, hospitals must go beyond what is just required by the current regulations in place. That can mean providing uniform prices for the same services, regardless of how those prices are sought. Read Full Article…

VBA Article Summary

1. Importance of User-Friendly Online Display: The hospital price transparency rule that came into effect in 2021 mandates hospitals to provide clear, easily accessible information on pricing for services and items. Despite CMS offering sample formats, many hospitals are still struggling to provide this essential data in a consumer-friendly manner. There is a pressing need for hospitals to innovate and simplify the way pricing information is displayed online to help patients make informed decisions.

2. The Inconsistency Dilemma: A recent study published in JAMA Internal Medicine showed that pricing information can vary significantly depending on the source within the same hospital. This inconsistency can deter patients from seeking care at the facility and erode trust. Hospitals must aim for uniformity in the pricing information they offer across various platforms, whether it be their website or over the phone.

3. Collaboration for Standardization: Tina Barsallo, VP of revenue cycle operations at Lifepoint Health, suggests that hospitals should consider collaborating with other providers to create tools and strategies for achieving pricing transparency and consistency. By working together, healthcare providers can share best practices, avoid redundancy, and more efficiently comply with CMS regulations. This approach could represent an effective solution for enhancing price transparency without needing to "reinvent the wheel."

US employers to see biggest healthcare cost jump in a decade in 2024

By Leroy Leo and Khushi Mandowara - U.S. employers are bracing for the largest increase in health insurance costs in a decade next year, according forecasts from healthcare consultants, but workers may be somewhat spared this time around in a tight labor market. Read Full Article…

VBA Article Summary

1. Rising Healthcare Costs for Employers in 2024: Benefit consultants from leading firms Mercer, Aon, and Willis Towers Watson predict that employer healthcare costs will spike between 5.4% and 8.5% in the coming year. The rise is attributed to medical inflation, increasing demand for expensive weight-loss drugs, and the broader availability of high-cost gene therapies. Aon has projected that a significant 1 percentage point of this increase could come from weight-loss drugs alone.

2. Employers Hesitant to Shift Costs to Employees: According to a survey by Mercer, over two-thirds of employers do not intend to pass the increased healthcare costs onto their employees. This reluctance is rooted in a desire to avoid adding financial stress to workers, especially when general inflation rates are also a concern. Beth Umland, Mercer's director of health & benefits research, points out that companies are relying more than ever on health benefits to retain employees in these trying times.

3. Strategies to Mitigate Rising Costs: As healthcare expenses climb, employers are exploring various approaches to control costs. The use of artificial intelligence to cut administrative expenses and increased scrutiny on the coverage of costly therapies are among the tactics being considered. Furthermore, companies and insurers are identifying less costly hospital networks for specific procedures to help contain costs. Janet Faircloth, senior vice president of Aon's health innovation team, highlights that employees are incentivized to opt for these networks through lower out-of-pocket expenses.

As the opioid crisis seethes, a long-lasting treatment could offer new ammunition

By Michael Gibney - The opioid crisis has devastated parts of the U.S., and millions are still struggling to find the right kind of treatment to get to the other side of dependence. It’s a matter of national importance that more opioid use disorder products enter the market, according to a statement from FDA Commissioner Robert Califf. Read Full Article…

VBA Article Summary

1. New Option in the Fight Against Opioid Addiction: The FDA has recently approved Brixadi, a time-released subcutaneous formulation of buprenorphine. Developed by Braeburn Pharmaceuticals, the drug aims to provide healthcare professionals and patients with more choices in treating opioid use disorders. Brixadi joins other medications like Suboxone and Sublocade but sets itself apart by offering both weekly and monthly dosages. Dr. Joshua Cohen, Braeburn’s chief medical officer, highlighted that having different options empowers patients and healthcare providers to tailor the treatment to individual needs.

2. Potential Benefits and Warnings: Brixadi has undergone clinical trials showing it to be superior to sublingual buprenorphine over a period of two years. Despite its promise, the drug comes with a black box warning cautioning against injecting it into a vein instead of subcutaneously. Due to this, it will only be administered by healthcare professionals. The approval and subsequent launch of Brixadi come at a crucial time when opioid overdose deaths have reached an all-time high, with 82,000 fatalities recorded in 2022 alone.

3. Partnerships and Future Directions: Braeburn is not acting alone in its mission to address the opioid crisis. The company is forming partnerships with various organizations, including grants for medical education and scientific research. They are also participating in National Recovery Month, which aims to engage communities in supporting recovery efforts. As the opioid epidemic continues to evolve, Dr. Cohen emphasizes that the pharmaceutical industry remains committed to developing more effective treatments and is optimistic about new molecules or mechanisms of action emerging in the future.

Mark Cuban, universities use 'secret shoppers' to gauge hospital prices

By Alexis Kayser - Hospital price quotes vary, depending on how you ask. A study published Sept. 18 in JAMA Internal Medicine explored this phenomenon. Mark Cuban co-authored the report, along with affiliates of multiple universities, including Baylor College of Medicine and Rice University, both based in Houston. Read Full Article…

VBA Article Summary

1. Discrepancies Between Online and Telephone Quotations: The study, which evaluated 60 U.S. hospitals—top-ranked, safety-net, and others—found significant inconsistencies between the cash prices quoted over the phone and those posted online. According to Vivian Ho, PhD, a co-author of the study, the telephone prices for services like vaginal childbirth and brain MRI were "substantially different" from online prices. In some instances, telephone quotes were less than half of what was listed online, highlighting hospitals' struggle to provide clear, consistent pricing information.

2. Varied Levels of Transparency Across Hospital Types: The study revealed that the level of transparency differs depending on the type of hospital. For brain MRI, 85% of top-ranked and 50% of safety-net hospitals provided pricing information both online and over the phone. In contrast, for vaginal childbirth, only 63% of top-ranked, 30% of safety-net, and 21% of unclassified hospitals did so. This suggests that even top-ranked hospitals are not uniformly transparent about their prices, making it difficult for patients to make informed decisions about their care.

3. Regulatory Gaps and the Call for More Transparency: Despite the Hospital Price Transparency Rule that mandates hospitals to post their prices online, many hospitals are not in compliance. According to a news release from Mr. Cuban on Sept. 20, the study underscores the need for further improvements in pricing transparency. A lack of transparent pricing affects patients' ability to compare costs and understand their financial responsibilities, hindering efforts to control healthcare costs in the U.S.

4 strategies employers are using to create attractive benefits

By John Feeney - In today’s hot labor market, employer-sponsored benefits continue to be a non-negotiable piece of the employee value proposition. But many factors, including inflation, economic instability and increased health care utilization as a result of the pandemic are driving up healthcare costs. Read Full Article…

VBA Article Summary

1. The Increasing Role of Voluntary Benefits: The article highlights how voluntary benefits like disability and life insurance are becoming increasingly important for employees. This trend has been particularly noteworthy during times of economic uncertainty. Employers are in a unique position to offer such benefits, as they can be partially or even fully paid for by the employee, allowing companies to add value without significant cost. Tax advantages for both the employee and employer also make these offerings financially savvy.

2. Tailoring Benefits to Employee Needs: A focus on employee priorities is crucial when designing a benefits program. The article suggests that employees are placing more importance on benefits that offer income protection and financial security. Employers can enhance the value of these benefits by including optional add-ons, such as student loan repayment benefits and travel assistance. This not only provides layers of financial security but also shows that the employer is attuned to the changing needs of its workforce.

3. Proactive Investment in Long-Term Health: Employers may aim to cut costs by scaling back on benefits, but the article argues that investing in preventive care and mental health can yield long-term cost savings. Offering dental and vision benefits can aid in the early detection of chronic conditions, potentially reducing future healthcare expenditures. Employee Assistance Programs (EAPs) that offer behavioral health support can also improve productivity by helping to mitigate the rising costs associated with poor mental health in the workplace.

Employee mental, physical & financial wellbeing remains low, study finds

By Lucy Peterson – Employees are losing trust in their employers amidst financial concerns and extensive layoffs that have sparked uncertainty over the last year, according to a study by Alight, an information technology and consulting company. Read Full Article…

VBA Article Summary

1. Alarming Wellbeing Statistics: A study by Alight reveals a concerning picture of employee wellbeing in 2023. The data shows that only 51% of employees feel positively about their overall mental, physical, and financial health. This is coupled with a decline in employer-employee trust, as only 41% believe their employers care about their wellbeing, a figure that has dropped by 6% since last year. In terms of mental health, stress is alarmingly prevalent, particularly among Gen Z and Millennial workers, where 80% report feeling moderate to high stress levels.

2. Critical Factors Contributing to Stress: Alight's report highlights that personal finances, job challenges, and physical health are the top three sources of stress for workers. Financial instability is particularly worrying, with 31% of employees stressed about their financial situation, and nearly half fearing that their finances control their lives. Additionally, despite being enrolled in employer health plans, only 62% of workers feel knowledgeable about selecting the right plan, and 44% have experienced regret over healthcare decisions, indicating a lack of appropriate guidance.

3. Barriers to Utilizing Employer Benefits: While over half of the workforce understands the benefits available to them, one-third do not utilize these resources due to various obstacles. These include a lack of time to evaluate offerings, overly complex access, or mismatched needs. A significant 85% of employees express that a 'one-stop-shop' model, like a mobile app for all benefits, would be useful. Alight experts, including Alison Borland and Laine Conway, emphasize the importance for employers to "cut complexities" and create streamlined, effective tools and communication strategies to help employees in their moments of need.