About pharma
House passes Speaker Nancy Pelosi’s drug pricing bill: But the bipartisan Senate version is different and a reconciliation is not expected before year’s end.
About health insurance
Billions in Estimated Medicare Advantage Payments From Chart Reviews Raise Concerns: The HHS Inspector General is concerned about the inaccuracy of risk adjusted payments to Medicare Advantage organizations (MAOs). The calculations, supported solely through chart reviews, “raise potential concerns about the completeness of payment data submitted to CMS, the validity of diagnoses on chart reviews, and the quality of care provided to beneficiaries.” One obvious problem is “that over 99 percent of chart reviews… added diagnoses” while deletions are not being made. Another finding is that “CMS based an estimated $2.7 billion in risk-adjusted payments on chart review diagnoses that MAOs did not link to a specific service provided to the beneficiary―much less a face-to-face visit.” Better review of these conditions is recommended.
Medicare to Make Good on Millions in Back Payments to Hospitals: “The American Hospital Association estimates that hospitals were shorted some $380 million in Medicare payments in 2019 under the “site neutral” payment policy implemented by the Centers for Medicare & Medicaid Services.”
About the public’s health
Grocers Amp Up Customer Health, Wellness Programs: “Of the respondents, 85% reported employing registered dietitians, with 70% of those at the corporate level and 27% of those at the regional level. One in three grocery stores reported having an in-store clinic for shoppers.”