From Global Impact to Medicare Moves – Here are the Latest Healthcare Developments

Our team was in Bangladesh last week supporting Radiant Healthcare, a firm that partners with hospitals, practices, and other healthcare organizations to provide revenue cycle optimization, credentialing verification, clinician enrollment, and more.

We toured two hospitals, attended a national book fair, executed the firm’s 20th anniversary celebrations, and revealed the new Radiant Data Systems logo.

The most inspiring part of our visit was spending time with the Radiant teammates who perform credentialing, enrollment, and RCM support functions. These dedicated and knowledgeable individuals are striving to help their U.S.-based clients navigate an inhospitable payment environment while building a better future for their families and their country. We hope to share some of their stories on Radiant’s website soon.

What was happening stateside while we were away? Click through to read the full newsletter. 

Government Shutdown Update: “Doc fix” included, but …

U.S. lawmakers passed their fourth short-term fiscal year 2024 funding bill last week and, over the weekend, released a longer-term funding plan for a handful of agencies. That draft includes language that would reduce planned reimbursement reductions to providers who serve Medicare patients. 

Specifically, this new draft offers a 1.68% boost in Medicare reimbursements. Combined with a 1.25% increase Congress provided for these providers late last year, this newest revision would result in a 2.93% payment bonus for 2024. Still, that number does not mitigate the full 3.4% pay cut the Biden administration finalized last fall.

We commend the advocates who have argued on behalf of providers — something is better than nothing — but this legislation does not do enough. Indeed, the incremental changes are miniscule when stacked again the power private payers have because of growing consolidation. 

Congress is making doctors fight over crumbs while private payers are sitting at the buffet.

While this draft is does not include controversial policy riders related to abortion that could have diminished support for the compromise, House conservatives already are lining up against the legislation. House Speaker Mike John (R-La.) will need to rely on moderate Democrats, compromise-minded conservatives, and … gasp! … Democrats to get this bill through the lower chamber of Congress. We will see what happens this week.

Your BIG thoughts: What more can be done? How can federal policymakers level the playing field between insurers and providers? 

Compounding the Problem: Change Healthcare Hack

If you have not heard about the Change Healthcare hack, you might be … alone. As The Associated Press reported, more than a week after the incident, providers were still reeling.

Why? They cannot get paid.

“The impact to hospitals is just now really starting to crystallize,” American Hospital Association (AHA) spokesperson Ben Teicher said. “[I]t can result in hospitals not being able to make payroll or patients still waiting for services to be approved.”

That’s right: the hack compounded provider difficulties associated with Medicare rates cuts and reimbursement struggles stemming from the No Surprises Act.  

Change Healthcare (CH) is owned by UnitedHealth Group (UHG). UHG said it would set up a loan program to help providers who cannot submit insurance claims while CH is offline. 

Nice try. 

In fact, AHA President and CEO Rick Pollack called the program “exceedingly small” and said the program’s terms and conditions are "shockingly onerous."

Congress could step in here. U.S. Senate Majority Leader Chuck Schumer (D-N.Y.) wrote a letter to the Center for Medicare and Medicaid Services asking it to make accelerated and advanced payments available to hospitals, pharmacies, and other providers affected by the hack. Read more at Becker’s Hospital Review. 

Update: According to Reuters, it appears United Healthcare has paid the $22 million in ransom to the hackers get their operations back online after providers waited days for reimbursements. 

In related news: the U.S. Department of Justice has begun an antitrust investigation into UHG.

Your BIG thoughts: If you a provider who was affected by the hack, we would love to hear about your experiences. What more could UHG be doing? 

CHAI: Bringing Stakeholders Together to Improve AI in Healthcare

“The success of AI in healthcare must be measured not only by its financial impact but also by its contribution to patient outcomes and healthcare equity,” Dr. Lidia Moura, a clinical neurologist at Massachusetts General Hospital, wrote at MedPage Today a week ago.

We could not agree more. Artificial intelligence (AI) holds enormous promise, but concerns about health equity are a challenge that will require all stakeholders to come together. As our Dr. Adam Brown wrote in his own MedPage Today column, trust is paramount.

According to Politico’s “Morning Pulse,” the Coalition for Health AI (CHAI) is working to build that trust and to ensure AI is safe and effective in healthcare. CHAI is public-private partnership between companies like Microsoft, providers like the Mayo Clinic, and government agencies like the U.S. Food and Drug Administration. 

“It is more important than ever to develop the right frameworks for trustworthy health AI that put the human person on top of the hierarchy,” CHAI Board Member and Duke University Chief Data Scientist Michael Pencina said.

Your BIG thoughts: Developing a code of ethics for the marketplace is essential, but government regulation will be necessary too. Will Congress catch up … how can it catch up? 

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