About health insurance/insurers
CMS finalizes 2.9% pay increase for outpatient facilities, ASCs, with new maternal health mandates “Under a final rule issued by the Centers for Medicare and Medicaid Services, hospital outpatient facilities and ambulatory surgical centers will get a 2.9% Medicare pay increase next year, up from the 2.6% boost in reimbursement that was floated in the draft rule.
Here is access to the full “unpublished document (scheduled for release 11/29/24)
Here is the CMS Fact Sheet.
Doctors, facing another pay cut in 2025, call for permanent Medicare payment reform “The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups.
CMS announced Friday it finalized the calendar year 2025 Medicare Physician Fee Schedule rule that sets payment rates for next year and also outlines new policies focused on primary care, preserved telehealth flexibilities and a strengthened Medicare Shared Savings Program (MSSP). A CMS fact sheet on the rule outlines the key provisions.”
As ACA sign ups start, more Americans have health insurance than ever. Will it last? “More than 21 million Americans buy their health insurance through the Affordable Care Act, and open enrollment for next year’s Obamacare plans started Friday, Nov. 1…
This year, premiums are still very affordable — for many people, premiums are $10 or less per month — and there are more plan options than ever…
One group that’s newly eligible for these subsidized marketplace plans is Deferred Action for Childhood Arrivals recipients, also known as Dreamers. Secretary Becerra says that an estimated 100,000 DACA recipients are expected to enroll…
Also new in 2025 is a rule that allows low income people to enroll in a marketplace health plan at any time of the year, not just during fall’s open enrollment period. That mirrors how enrollment works for Medicaid, the public health insurance program for people with low incomes.
Insurance companies will also have to follow new limits on how long patients should have to wait to get a doctor’s appointment.”
Maryland is the first state to sign into new federal health care program “Maryland became the first state on Friday to join a federal program designed to improve health care quality and equity while lowering costs for all health care payers, including Medicare, Medicaid and private insurers.
It builds on Maryland’s Total Cost of Care Model, which sets a per capita limit on Medicare’s total cost of care in Maryland and encompasses the state’s unique all-payer hospital payment system, which reduces per capita hospital expenditures and supports improved health outcomes, as encouraged by the Affordable Care Act.
This new federal framework, known as the AHEAD model, has been designed to deliver high-quality health care through greater coordination, with a focus on health equity and social needs to support underserved patients.”
Medicare Advantage Plans With High Numbers Of Veterans: Enrollment, Utilization, And Potential Wasteful Spending “Medicare Advantage (MA) plans are increasingly enrolling veterans. Because MA plans receive full capitated payments regardless of whether or not veterans use Medicare services, the federal government can incur substantial duplicative, wasteful spending if veterans in MA plans predominantly seek care through the Veterans Health Administration (VHA) system. The recent growth of MA plans that disproportionately enroll veterans could further exacerbate such wasteful spending. Using national data, we found that veterans increasingly enrolled in MA between 2016 and 2022, including in a growing number of MA plans in which 20 percent or more of the enrollees were veterans. Notably, about one in five VHA enrollees in these high-veteran MA plans did not incur any Medicare services paid by MA within a given year—a rate 2.5 times that of VHA enrollees in other MA plans and 5.7 times that of the general MA population. Meanwhile, VHA enrollees in high-veteran MA plans were significantly more likely to receive VHA-funded care. In 2020, the Centers for Medicare and Medicaid Services paid more than $1.32 billion to MA plans for VHA enrollees who did not use any Medicare services, with 19.1 percent going to high-veteran MA plans.” [Emphasis added]
Expected Out-Of-Pocket Costs: Comparing Medicare Advantage With Fee-For-Service Medicare “We compared the generosity of Medicare plans in terms of out-of-pocket costs attributable to cost sharing and premiums, including both basic and supplemental services. From 2014 through 2019, projected out-of-pocket costs for a typical enrollee were 18–24 percent lower in Medicare Advantage than traditional fee-for-service Medicare.”
Health Benefits In 2024: Higher Premiums Persist, Employer Strategies For GLP-1 Coverage And Family-Building Benefits “In 2024, the average annual premium for employer-sponsored family health coverage was $25,572, an increase of $1,604 (7 percent) from 2023. Over the course of the past five years, the average family premium has increased 24 percent, which is similar to growth seen in inflation (23 percent) and wages (28 percent). On average, covered workers contributed 16 percent ($1,368) of the cost of single coverage and 25 percent ($6,296) of the cost of family coverage. The average general annual deductible for single coverage for workers with a deductible was $1,787, similar to that in recent years but 47 percent higher than a decade ago. In 2024, 18 percent of large firms offering health benefits, including 28 percent of those with 5,000 or more employees, covered GLP-1 antagonists for weight loss. Large employers were more likely to perceive their overall provider networks as broader than their networks for mental health and substance use conditions.”
About hospitals and healthcare systems
US Nonprofit Hospitals Have Widely Varying Criteria To Decide Who Qualifies For Free And Discounted Charity Care “Among hospitals that offered free care, income limits ranged from 41 percent to 600 percent of the federal poverty guideline. Many hospitals considered assets when determining eligibility for charity care, and a significant minority also had residency requirements and restrictions for insured patients. Hospitals generally allowed charity care in cases of hardship, with a median cutoff of a given hospital bill being 20 percent of the patient’s income. Hospitals in counties with lower levels of poverty and uninsurance had more generous eligibility policies. The wide variation in requirements for hospital financial assistance poses barriers to equitable access to care.”
Days of cash on hand at 35 health systems “Median days cash on hand dipped to a 10-year low for U.S. hospitals and health systems, according to an Aug. 7 S&P Global Ratings' report.
For the first time in the last decade, average days cash on hand dropped below 200 to 196.8, according to the report. The upper half of U.S.-based nonprofit acute healthcare providers reported an average of 292 days while the lower half reported 128 days on average.”
About pharma
What really happens to drug prices when patents expire A great video explaining why prices do not come down when patents are expected to expire.
About the public’s health
COVID vaccine removed from Idaho district county health clinics: 5 things to know “The Southwest District Health Board voted 4-3 to remove COVID-19 vaccines from its facilities after receiving around 300 public comments urging the removal. The decision was followed by anti-vaccine presentations from multiple doctors widely accused of spreading misinformation, the outlet reported….
The removal marks the first instance in the U.S. where a health department is restricted from offering the COVID-19 vaccine.”
Comment: BELIEVE POLITICAL CANDIDATES WHEN THEY SAY THEY WILL REMOVE VACCINATIONS!
In a related article: Florida surgeon general who warned against vaccines may lead HHS under Trump “Florida’s top health official, whose tenure has been marked by his warnings against vaccines, threats to TV stations for running abortion ads and frequent clashes with public health experts, has emerged as a candidate to run the Department of Health and Human Services in a potential Trump administration, according to two people familiar with the process.”
