HealthCare Roundtable e-News – December 22, 2023

 

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Save the Date: Congressional Update Webinar – Wednesday, January 10, 2024 at 3:00 PM EST

(Details, including a registration link, will be shared on January 2, 2024.)

 

Next e-News: Monday, January 8, 2024


Top News

KFF Publishes Analysis on Shift Toward Medicare Advantage in Employer-Sponsored Retiree Health Plans

The Kaiser Family Foundation (KFF) recently released an analysis on the evolving landscape of employer and union-sponsored retiree health plans in the context of Medicare, focusing on data from the 2023 KFF Employer Health Benefits Survey. It notes a significant decline in the share of large employers offering retiree health benefits, particularly to Medicare-age retirees. The study reveals that, among the diminishing proportion of large firms providing such benefits, Medicare Advantage has gained popularity. In 2023, approximately half (52%) of large employers offering retiree health benefits to Medicare-age retirees do so through a Medicare Advantage plan, marking a doubling of this figure from 2017.

The analysis explores the reasons behind this trend, emphasizing that employers are increasingly turning to Medicare Advantage as a strategy to manage retiree health benefit costs. The shift to Medicare Advantage may allow employers to maintain benefits for retirees while potentially reducing costs. However, the analysis also highlights potential drawbacks for retirees, such as more limited access to healthcare providers within the plan’s network and increased exposure to cost management tools. Furthermore, retirees who opt for traditional Medicare may risk forfeiting their retiree benefits.

The rising number of Medicare-eligible retirees enrolling in Medicare Advantage plans also raises concerns about its impact on Medicare spending. Medicare pays more for enrollees in Medicare Advantage plans than for those in traditional Medicare, contributing to higher overall Medicare spending. This, in turn, has implications for the solvency of the Medicare Trust Fund and may result in higher Medicare premiums for all beneficiaries. The analysis questions whether employers are limiting their liability for retiree health benefits at the expense of the Medicare program.

 

Departments Release Surprise Billing Fee Final Rule

The Departments of Health and Human Services, Labor, and the Treasury (the Departments) finalized fees associated with use of the federal independent dispute resolution (IDR) process under the No Surprises Act (NSA). As required by statute, both parties to a dispute must pay a non-refundable administrative fee for participating in the Federal IDR process. Key provisions in the final rule are highlighted below:

  • The administrative fee will be $115 per party for disputes initiated on or after the effective date of the rule. The certified IDR entity fee will range from $200-$840 for single determinations and $268-$1,173 for batched determinations.
  • For batched determinations exceeding 25 dispute line items, certified IDR entities may set a fixed fee within the range of $75-$250 for each increment of 25 dispute line items included in the batched dispute, beginning with the 26th line item.
  • The fees will remain in effect until the Departments propose and finalize different fee amounts in subsequent notice and comment rulemaking.
  • The administrative and certified IDR entity fee amounts will be established no more frequently than once per calendar year.

Administrative Action

Last week, the Office of the National Coordinator for Health Information Technology (ONC) finalized a rule that will require more transparency with artificial intelligence used in clinical settings. The Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) rule would further implement provisions of the 21st Century Cures Act and make updates to the ONC Health IT Certification Program – a certification program that includes various standards, implementation specifications and certification criteria for electronic health record (EHR) software companies and health IT developers. The rule will apply to clinicians using HHS-certified decision support software by the end of 2024. The regulations will require software developers to provide more data to customers with the aim of allowing providers to determine whether AI is “fair, appropriate, valid, effective and safe.” Software developers will also have to tell their customers how representative the AI’s training data is, how they attempted to mitigate bias and how the software was externally validated. Additionally, they’ll have to reveal performance measures, explain how they monitor performance over time and describe how often they update algorithms. Additionally, the Biden-Harris Administration announced voluntary commitments from 28 health care provider and payer organizations to ensure AI is deployed safely and responsibly in health care.

Research

  • According to Gallup’s 2023 Health and Healthcare survey, nurses have the highest rating among Americans (82% individuals shared they provide excellent or good medical care), followed by doctors (69%). This survey examined Americans’ views of healthcare players in providing quality medical care/services. Positive ratings dropped for hospitals (58%), walk-in clinics (56%), and telemedicine (52%). In addition, less than half of respondents gave positive ratings to emergency rooms (47%), pharmaceutical companies (33%), health insurance companies (31%), and nursing homes (25%). These findings follow a West Health-Gallup poll which found 70% of Americans resist living in nursing homes, citing skepticism about care quality. Nurses maintain a high rating, while other healthcare entities’ scores decline. Since 2010, positive perceptions have sharply dropped, possibly influenced by higher healthcare costs, the opioid crisis, the COVID-19 pandemic, vaccine controversies, and healthcare staff shortages. Doctors now lag behind nurses in rating, and hospital emergency rooms fall behind walk-in clinics. While a slight majority approves of telemedicine, it lags behind physicians in perceived quality, indicating concerns about virtual healthcare.
  • A recent publication in JAMA Network Open delves into the field of healthcare algorithms, presenting a conceptual framework and essential principles to address biases within them. Aligned with the Biden Administration Executive Order 14091, Further Advancing Racial Equity and Support for Underserved Communities Through The Federal Government, the Agency for Healthcare Research and Quality and the National Institute for Minority Health and Health Disparities convened a panel to recommend core guiding principles for the development and use of clinical algorithms in health care, including data-driven, probability-based algorithms such as those using artificial intelligence and machine learning approaches. The panel developed a conceptual framework to apply the below guiding principles across an algorithm’s life cycle, centering health and health care equity for patients and communities as the goal, within the wider context of structural racism and discrimination.

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