While we wait to see if Congress will sign off on an agreement the President and the Speaker of the House negotiated as a way for the country to avoid recession, let’s update some healthcare issues that we’ve been following lately.
First off, the physician staffing firm Envision Healthcare has filed for bankruptcy, citing the No Surprises Act as one of the primary reasons for its demise. Envision saw its profits decline during the pandemic; the company faced multiple legal battles with UnitedHealthcare, and the company said that the No Surprises Act caused them to lose hundreds of millions of dollars in delayed or reduced payments from insurers.
Even before the launch of the No Surprises Act in January 2022, many experts suggested that private equity-backed provider firms would be impacted by the law, and Envision lobbied against the Act before it was passed. In the first six months of the law’s implementation, private equity-backed firms initiated 40 percent of the disputes on reimbursement, with Envision itself accounting for 3 percent.
Despite the bankruptcy, the company says that its clinical operations will continue without interruption.
Moving to our next story, as you may know, at the end of March, a judge in the U.S. District Court in the Northern District of Texas issued a ruling that removed the Patient Protection and Affordable Care Act (PPACA) requirement that insurers cover preventive services.
Last week, however, the Fifth Circuit Court ruled in favor of a stay while it reviews the case. In other words, for the moment, insurers still have to cover preventive services until the case is decided. Regardless, many insurers have come forward and said they will continue to cover preventive services at no cost, regardless of the outcome of the case.
In other news, as many of us know, the federal Public Health Emergency (PHE) has ended. Odd, isn’t it, that after all that, the long pandemic, the impacts to government, schools, our jobs, society, our mental state…all of that was proclaimed over, without much fanfare. I’m not quite sure what to do with that.
But, of course, COVID is not through with us. As reported here, with the end of the PHE, an estimated 15 million people will lose Medicaid. While many will still be eligible for the program and others will be eligible for employer or PPACA plans, we expect that many will still fall through the cracks and become uninsured.
Uninsured individuals mean uncompensated care, which translates into more cost pressure for you all, for providers. The government is also removing its coverage and reimbursement for COVID tests and treatment, shifting that to insurers and the patients themselves – and again, that will likely result in some cost pressures for providers.
Finally, of course, despite the Administration and the World Health Organization (WHO) calling the pandemic all but over, again, the virus itself is still with us. As of the beginning of May, there were over 1,300 new COVID hospitalizations a day, and over 1,000 new deaths weekly. The ability to track that data, by the way, will also go away with the PHE.
Ninety percent of the nation’s over $3 trillion spent on healthcare is spent on chronic or mental healthcare, and COVID will end up adding to that number.
An estimated 16 million working-age Americans have long COVID. And COVID has apparently increased the prevalence of heart conditions. There are at least 160 peer-reviewed research studies that identified a positive relationship between the COVID infection and new cardiac conditions.
Finally, we know that the pandemic affected mental health in this country. Mental health visits are up 15 percent from pre-pandemic times, and 90 percent of Americans are calling the state of mental health in this country an epidemic.
The emergency may have ended two weeks ago, but we’ll be paying for COVID in many ways for a long time.
As a provider, a question worth asking yourself these days is this: what degree of risk is there that you might have something on your
If one judges by statistics and performance scorecards alone, in the United States, healthcare means high cost and low quality. The expenditures are enormous. Healthcare
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