American Academy of Dermatology’s Guide to Sunscreen

American Academy of Dermatology’s Guide to Sunscreen

Summer is here, and many people are spending more time outside, swimming, and taking vacations. It is crucial to wear sunscreen to protect yourself from the sun. Read below for more information from the American Academy of Dermatology about the importance of sunscreen!

With Memorial Day marking the unofficial start of summer and the reopening of many beloved outdoor activities after the COVID-19 shutdown, it’s more important than ever to remember your sunscreen—especially after many of us spent months indoors. The American Academy of Dermatology (AAD) offers a great two-minute video and five tips for proper sun protection.

So get outside, enjoy your favorite activities, and don’t forget to apply that sunscreen. It’s finally summer! Click here to read more about sunscreen from the AAD.

Amazon Is Already Reshaping Health Care

Amazon Is Already Reshaping Health Care

Amazon In The Healthcare Space

The mere threat of Amazon.com Inc. entering the health care market has already started transforming U.S. health care, and not necessarily for the better. This looming presence has accelerated consolidation, leading to potential consumer disadvantages.

The speculation about Amazon’s involvement prompted two of the largest pharmacy benefit managers, CVS Health Corp. and Express Scripts Holding Co., to merge with major insurers, Aetna Inc. and Cigna Corp. These mergers consolidate more of the U.S. health care system under fewer companies. While the merging companies claim this will reduce costs for consumers and the nation, the reality is likely to be more complex and less favorable.

About The Mergers

These mergers were made possible partly due to the Federal Trade Commission and the Department of Justice blocking the mergers of Anthem Inc. with Cigna and Aetna with Humana Inc. These mega-insurers would have been too preoccupied with their own integrations to pursue such vertical deals and would have been too large to be acquired by other insurers.

UnitedHealth Group Inc. has also played a significant role in motivating these mergers. It pioneered aggressive diversification by acquiring a large PBM in 2015 and through its Optum health-services unit. Its success in patient enrollment, revenue growth, and market valuation has set a benchmark, inspiring similar strategies among its peers. Additionally, profit pressures on PBMs likely made them more open to merging with insurers.

However, Amazon’s potential entry into the health care market is a significant factor driving these deals. Amazon’s technological capabilities, long-term investment approach, vast appetite for new ventures, and tolerance for thin margins have unsettled investors, especially those involved in the industry’s middleman roles. If these mergers are finalized, the result will be unprecedented market concentration, with the three largest U.S. PBMs tied to three of the largest insurers.

Effects On Prescriptions

CVS, Express Scripts, and UnitedHealth currently process over 70% of all U.S. prescriptions. Post-merger, three companies will manage the insurance of over 90 million people, process more than 3.5 billion prescription claims, and generate over $500 billion in revenue. While not every American will have both their medical and drug benefits managed by the same company, many more will in the future.

These integrated companies will have more comprehensive information about their customers and a greater ability and incentive to manage total health spending. UnitedHealth is already deeply integrated, with investments in ambulatory surgery centers and physician groups. The merger of CVS and Aetna, which adds retail pharmacies and primary care clinics to the mix, could significantly impact patient lives.

CLICK HERE to view the original article in its entirety, including informational charts, graphs, and author info.

 

AMA Urges Congress to Update Medicare Physician Payment System

AMA Urges Congress to Update Medicare Physician Payment System

The American Medical Association (AMA) recently sent a letter to congressional leaders advocating for updates to the Medicare Physician Payment System. Following a Medicare Payment Advisory Commission (MedPAC) report, the AMA has urged Congress to implement a stable annual payment rate that aligns with inflation and practice costs.

The MedPAC report, presented to Congress on March 15, 2022, recommended maintaining the freeze on Medicare physician payment rates and not increasing them for 2023. The AMA has expressed significant concerns about this recommendation, emphasizing that it would negatively impact patient access to care as practice costs rise.

MedPAC’s report stated that despite the decline in Medicare service volume and revenue due to the pandemic, Congress provided substantial relief funds to clinicians. MedPAC expects these volumes and revenues to rebound to pre-pandemic levels by 2023. However, the AMA argues that financial challenges persist for physicians. They cite ongoing fiscal uncertainties related to the COVID-19 pandemic, statutory payment cuts, the consistent lack of inflationary updates, and significant administrative barriers as major issues affecting the stability of the Medicare physician payment system.

Inconsistency In Recommendation

The AMA also highlighted the inconsistency in MedPAC’s recommendation to freeze physician payment rates while CMS projects an 80 percent increase for Medicare Advantage plans in 2023. Data from the Medicare Trustees show that Medicare physician pay has increased by only 11 percent from 2001 to 2021, with one-third of that increase coming from a temporary 3.75 percent update set to expire this year. In contrast, Medicare hospital and skilled nursing facility payment rates have increased by over 60 percent during the same period. When adjusted for inflation, Medicare physician payment rates have declined by 20 percent over the past two decades, while the costs of running a medical practice have risen by 39 percent since 2001.

Additionally, Medicare physician fee schedule spending per enrollee has declined by 1 percent over the last ten years, while other Medicare benefits spending has significantly increased. For instance, Part B fee-for-service spending per enrollee, excluding physician fee schedule spending, rose by 42 percent over the last decade. Part A fee-for-service spending increased by 3.6 percent, Part C spending by 29.4 percent, and Part D spending by 20 percent.

Free Set To Continue Until 2026

The Medicare physician payment freeze is set to continue until 2026, after which payment updates will resume at a rate of 0.25 percent per year, far below the rate of medical or consumer price index inflation. The AMA warns that unless Congress updates Medicare physician payments to reflect inflation, the gap between payment rates and rising practice costs will continue to widen.

The AMA also referenced a May 2021 study that revealed the high costs of compliance with the Medicare Merit-Based Incentive Payment System (MIPS), amounting to around $12,800 and over 200 hours per physician annually. Furthermore, physicians have not been able to receive annual incentive payments for Medicare Advanced Alternative Payment Models (AAPM) due to the lack of transition opportunities.

The AMA stressed that financial hardships, burnout, and stress are driving many physicians to consider leaving their practice within two years. While expressing gratitude to Congress for the financial relief provided during the pandemic and for preventing a 10 percent physician payment cut in 2022, the AMA urged officials to collaborate with the physician community to develop solutions to the systemic issues plaguing the Medicare physician payment system.

Original article published on revcycleintelligence.com

AMA, CMS, and Manatt Health Release Study on Colorado’s Efforts to Combat the Opioid Epidemic

AMA, CMS, and Manatt Health Release Study on Colorado’s Efforts to Combat the Opioid Epidemic

Colorado Opioid Epidemic

A spotlight analysis by the American Medical Association (AMA), Colorado Medical Society (CMS), and Manatt Health reveals significant progress in Colorado’s efforts to address the opioid epidemic. The report highlights reforms that have been implemented, while also recommending further steps for policymakers, insurers, and physicians to save more lives.

Analysis Information

The analysis found that Colorado has made notable strides in increasing access to evidence-based treatment for substance use disorders. Several pilot projects have improved care for patients with pain, and increased access to naloxone, the opioid overdose-reversing drug, has saved thousands of lives. “We conducted this analysis because it’s essential that policymakers know what is working and where additional progress can be made,” said AMA President-elect Dr. Patrice A. Harris, who also chairs the AMA Opioid Task Force. “Colorado has implemented many important policies that are impacting patients’ access to care. Using this momentum, we think Colorado can go even further to save lives of those affected by opioid use disorder.”

This Colorado study is the second in a series of individual state analyses by the AMA, following a recent study on Pennsylvania. Based on data, policy reviews, and discussions with key policymakers, the analysis identified four key areas of success in Colorado.

4 Key Areas Of Success

  1. Adoption of Policies and Funding to Increase Access to Medication-Assisted Treatment: Initial steps have been taken to reduce administrative barriers, increase funding to address workforce issues, and expand Medicaid coverage in residential settings.
  2. Compliance with Mental Health and Substance Use Disorder Parity Laws: The Colorado Division of Insurance is reviewing insurers’ conduct and has established an ombudsman’s office to help patients access behavioral health care.
  3. Increasing Access to Non-Opioid Pain Management for Medicaid Patients: Coverage has been extended to non-opioid prescription medications and alternative therapies, such as physical and occupational therapy, and additional behavioral health care options.
  4. Expanding Access to Naloxone: Early legislation, a standing order for naloxone, Good Samaritan protections, and the elimination of prior authorization for naloxone under Medicaid have been implemented.

“This analysis comes at an important time for Colorado,” said Dr. Debra Parsons, CMS President. “Over the last six years, Colorado has developed policies, enacted laws, and made significant strides in uniting stakeholders to reverse the opioid epidemic. While we continue these successful initiatives, we must closely evaluate their effectiveness to ensure we are directing our efforts appropriately.”

The analysis also highlighted the work of the Colorado Consortium for Prescription Drug Abuse Prevention, which has united hundreds of stakeholders and continues to develop a data-driven dashboard to help direct resources to areas of greatest need. Additionally, the report identified areas for further improvement:

  • Eliminating Barriers to Treatment: Further steps are needed to enforce mental health and substance use disorder parity.
  • Expanding Access to Medication-Assisted Treatment Providers: Especially in rural areas of the state.
  • Leveraging Successful State Pilots: To increase access to multimodal pain care and comprehensive benefit and formulary designs.
  • Linking Naloxone Recipients to Follow-Up Treatment: To begin and sustain recovery.
  • Evaluating State Policies and Programs: To determine what is improving patient care and reducing opioid-related harms, and to identify any unintended consequences of current policies.

“Many recommendations in this report, especially those related to commercial insurance—such as improving enforcement of mental health parity and conducting more comprehensive reviews of addiction professionals in insurers’ networks—are fair and reasonable steps we can tackle immediately,” said Michael Conway, Colorado Insurance Commissioner and head of the state’s Division of Insurance. “We look forward to working with Colorado’s health insurers and physicians to implement solutions that ensure consumers receive the care they need to help end our state’s opioid epidemic.”

Click here to read the original article on cms.org.

New Resources Available for Understanding the No Surprises Act

New Resources Available for Understanding the No Surprises Act

Are you worried about surprise medical bills? The recently passed No Surprises Act aims to protect consumers, but many people are still unsure about its implications. Fortunately, several organizations have added resources to help you understand the new legislation. Read on to learn more.

Advisories, information sheets, and FAQs are now available to assist hospitals, health systems, physicians, and consumers in navigating the new rules against surprise billing. Despite ongoing legal challenges, key elements of the No Surprises Act took effect on January 1, and various stakeholder organizations are offering guidance to their members.

Latest Updates:

American Hospital Association (AHA):

  • On Friday, the AHA published a legislative advisory summarizing the No Surprises Act and its key takeaways. The advisory includes a 15-page detailed summary of the rules. “The hospital and health system field strongly supports protecting patients from surprise medical bills,” the AHA stated. They believe this legislation is a significant step forward in patient protection. The AHA’s advisory webpage also links to additional resources, including an FAQ on good faith estimates for uninsured/self-pay patients, details about the AHA/AMA lawsuit challenging billing dispute resolutions, and information on CMS guidance

 

American Medical Association (AMA):

  • Also on Friday, the AMA published an advocacy update for physicians. It includes a new toolkit focusing on three key issues: notice-and-consent requirements for out-of-network care at in-network facilities, rules about emergency and post-stabilization care, and good faith estimates for self-pay and uninsured patients. An AMA Advocacy Insights webinar on January 20 will explore these topics further.

 

Centers for Medicare & Medicaid Services (CMS):

  • CMS added new online resources for consumers explaining their new billing protections effective January 1. These include protections for emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. The CMS website states, “Through new rules aimed at protecting consumers, excessive out-of-pocket costs are restricted, and emergency services must continue to be covered without prior authorization, regardless of network status.” The page also provides links to resources that explain what surprise bills are and the new consumer protections.

 

Additional resources for hospitals and health systems are available from the Healthcare Financial Management Association and the Medical Group Management Association.

For more details, visit the original article on healthleadersmedia.com.

Welter Healthcare Partners Earns Prestigious NCQA Credentials Verification Organization (CVO) Certification

Welter Healthcare Partners Earns Prestigious NCQA Credentials Verification Organization (CVO) Certification

Arvada, CO April 2024 — RT Welter and Associates, Inc. DBA Welter Healthcare Partners (WHP), a leading provider of comprehensive healthcare business management solutions, proudly announces its achievement of National Committee for Quality Assurance (NCQA) Credentials Verification Organization (CVO) Certification. This recognition underscores WHP’s commitment to delivering unparalleled quality, security and excellence in credentials verification for over 30 years.

Achieving this honor places Welter Healthcare Partners in an elite group of six companies that have achieved the coveted URAC Accreditation and NCQA Certification for Credentials Verification Organization (CVO).

NCQA is a private, nonprofit organization dedicated to improving healthcare quality. NCQA accredits and certifies a wide range of healthcare organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. In recognition for its leadership in diversity, equity and inclusion, NCQA has won the Excellence in Diversity Award from the Chesapeake Human Resources Association. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make more-informed healthcare choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, and on LinkedIn at linkedin.com/company/ncqa.

CVO Certification includes rigorous on-site evaluations conducted by a team of healthcare professionals and certified credentialing specialists. A national oversight committee of physicians analyzes the team’s findings and determines certification based on the CVO’s compliance with NCQA standards.

“Our team at Welter Healthcare Partners is immensely proud to achieve NCQA CVO Certification,” said Todd Welter, Chairman and CEO at WHP. “This recognition reflects our ongoing commitment to delivering exceptional CVO value and expertise to our clients. We are grateful for the validation of our dedication to quality, compliance, security, and accurate credentials verification and look forward to continuing to serve our clients with excellence.”

The NCQA CVO Certification reinforces WHP’s ability to provide managed healthcare services with excellence, benefiting both the organization and its members and clients. WHP’s expertise and dedication are translated into tangible benefits for its clients, enabling them to navigate the complexities of network management and expansion successfully. With NCQA CVO Certification, and URAC CVO Accreditation, WHP reaffirms its position as a trusted partner in the healthcare industry.

For more information about Welter Healthcare Partners and its comprehensive healthcare management solutions, visit welterhp.com or contact Jennifer Heuer at jh@welterhp.com or 303-534-0388.

About Welter Healthcare Partners:

Welter Healthcare Partners (WHP) is a leading provider of comprehensive healthcare business management solutions, and credentials verification; empowering physician practices, healthcare providers, payers, hospitals, and organizations of all types to thrive in the dynamic healthcare landscape so they can focus on providing the highest quality healthcare to their patients. With over 30 years of experience, WHP delivers unparalleled expertise and support to its clients, ensuring their success, sustainability, compliance and profitability.

Media Contact:

Jennifer Heuer

Welter Healthcare Partners

Email: jh@welterhp.com
Phone: 303-534-0388