JustCare

Tag: Hospitals

  • Half of rural hospitals are losing money, closing units

    Half of rural hospitals are losing money, closing units

    Jazmin Orozco Rodriguez reports for Kaiser Health News on the failing finances of half of rural hospitals. They are losing money. A big part of the reason are the insurers offering Medicare Advantage plans who don’t pay these hospitals the money they are due.

    “The rapid growth of rural enrollment in Medicare Advantage plans, which do not reimburse hospitals at the same rate as traditional Medicare, has had a particularly profound effect.” Insurers don’t profit as much from rural enrollees, so they do not pay rural hospitals adequately, which our government unforgivably allows them to do. (Most people don’t appreciate that government payments to Medicare Advantage plans are based on the payment rates in traditional Medicare.)

    What’s happening? In many cases, rural hospitals are closing their operating rooms and obstetrics units. Hundreds of hospitals have stopped providing chemotherapy. Expenses are greater than revenue. Hospitals cannot find enough workers. And, administrative challenges are large.

    Where are the hospital closures happening? All over the US, particularly in small communities. Chartis describes that, in the last year alone, one in two rural hospitals operated in the red. That’s nearly a ten percent increase from the year before.

    How many hospitals are at risk? Chartis found that 418 rural hospitals were at risk of closing. Of note, those rural hospitals in states with expanded Medicaid coverage were in better shape financially than those in states that did not opt to expand Medicaid.

    Medicaid expansion to low-income adults has helped ensure access to care health care in those states a lot: In Montana, for example, as a result of Medicaid expansion, there are half as many uninsured residents as there had been. Access to care for Montanans has improved. And, rural facilities are still operating. No hospitals have closed in the last nine years.

    The future looks grim for rural hospitals and the people who live in their communities, according to Chartis. Even non-profit hospitals can’t survive financially in rural America. The hospitals have no profit margin. Rural residents tend to live on low incomes, to be older and in poorer health. Overall, they have shorter life expectancies than Americans living in other areas.

    Alan Morgan, CEO of the National Rural Health Association notes that Congress needs to do more: “It’s just bad public policy. And bad policy for the local communities.”

    Here’s more from Just Care:

  • Hospitals, physicians and pharmacies left unpaid after a UnitedHealth cyberattack

    Hospitals, physicians and pharmacies left unpaid after a UnitedHealth cyberattack

    What happens when a corporate health insurance company, Change Healthcare, a division of UnitedHealth Group, has its computer system hacked and can’t pay claims electronically? Even when Medicare claims are at issue, the Centers for Medicare and Medicaid Services (CMS) can only urge UnitedHealth to behave ethically. Darius Tahir et al. report for Kaiser Health News that physicians, hospitals and pharmacies are left in the lurch.

    Our health care system is so poorly designed that even when a government program is involved, the government can do little more than ask the insurer to mitigate a problem–even serious problems such as inability to pay electronically about 50 percent of all physician claims–voluntarily. The insurer wants to spend as little money as possible to resolve the problem and feels no ethical, let alone legal obligation, to find a workaround. One advocate nails the problem: “the purely optional, do-this-out-of-the-goodness-of-your-heart model clearly is not working.”

    UnitedHealth appears in no rush to help providers, saying its systems for paying claims will get fixed later this month. In the meantime, it has created inadequate workarounds. It is offering practices with hundreds of thousands of dollars in weekly revenue as little as $540 a week.

    CMS is asking UnitedHealth to do better. Providers need more money. Alternatively, CMS is suggesting that providers file paper claims or switch away from Change Healthcare to a different company to pay their bills, which for many providers is easier said than done.

    The White House is also asking UnitedHealth to do more to help ensure providers are reimbursed appropriately and without delay.

    Meanwhile, some pharmacies are asking patients to pay the full cost of medications. Some physician practices are struggling to pay their bills. They are out millions of dollars.

    Policymakers and experts would like the Biden administration to do more. But, except with regard to claims it pays directly in Traditional Medicare, it has limited authority since it turned over Medicare Advantage claims payment to corporate insurers. Congress should reconsider the consequences of the government not fully controlling claims payment in our healthcare system.

    Saad Chaudhry, an executive at Maryland hospital system raises a darker issue. What is UnitedHealth really up to? He asks, “Do you believe these thieves? Do you believe the organization itself, that has everything riding on their public image, who have incentives to minimize this kind of thing?” Whether you believe UnitedHealth or not, health care providers and their patients should never be in this situation.

    How does the government protect against cyberattacks down the road, when our health care system is so fragmented? There are scores of cyberattacks each year against health care entities. For sure, the government should require system redundancies so that if one insurer is hacked providers have other options for getting paid. But, if the government were in control of claims payments, it would have the power to do whatever workarounds were necessary to ensure payment to providers if its systems were hacked.

    Congress should be on top of this now. One thing’s for sure. Cyberattacks will continue.

    Here’s more from Just Care:

  • Medicare Advantage and other HMOs compromise continuity of care

    Medicare Advantage and other HMOs compromise continuity of care

    If you’re in a Medicare Advantage plan or any health insurance plan that requires you to use in-network health care providers and you have not thought about the fact that you can’t count on your health plan covering those physicians and hospitals over time, you should. In fact, right now, hospitals and physicians are dropping like flies from a large number of health plans. Melanie Evans reports for the Wall Street Journal about the ugly situations patients in these health plans are facing.

    One reason to stay away from Medicare Advantage plans–which cover your care from in-network providers only or which cover only some of the cost of your care from out-of-network providers–is that you might end up having to switch physicians mid-course of treatment. That seems to be happening to tens of thousands of people in Medicare Advantage plans and other health plans in the last couple of years. The corporate health insurers offering Medicare Advantage plans too often are denying payments to hospital systems and forcing physicians to go through multiple hoops to get care approved, at enormous cost to them. So, the hospitals and physicians are fighting back, refusing to contract with the insurers.

    Lots of patients are hearing from their local hospitals and physicians that their insurance will no longer cover their care from these providers. Hospitals want more money and less headache. They say that insurer prior authorization rules are endangering the health and well-being of their patients.

    Patients, in turn, are left in a serious quandary. Stay with their longtime physicians and hospitals and be liable for the full cost of their care, often thousands or tens of thousands of dollars. Or, switch to new hospitals and physicians, which can compromise their health. Moreover, switching care providers is almost always a total headache and challenging in and of itself.

    A lot of the problem stems from the fact that unlike other wealthy nations, the US does not set provider rates, we leave it to the health insurers to negotiate them. It’s a recipe for insanity. If providers have a lot of power, the rates can be excessive. If the insurers have all the power, the rates can be so low as to threaten the quality of care.

    For example, in Medicare Advantage, insurers can spend less if they don’t contract with cancer centers of excellence. But, the latest research suggests that means patients are likely to get poor quality cancer care and face higher mortality rates.

    What’s worse is that our health care system allows insurers offering Medicare Advantage plans and all other health plans the discretion to decide when care is covered. If they’re facing pressure from Wall Street to return greater profits, the insurers can stint on care. The less care they cover, the more money they get to keep and the more they profit.

    In January, UnitedHealth ended some in-network coverage from Mount Sinai in New York City. On March 1, UnitedHealth terminated contracts with other Mount Sinai hospitals. As of March 22, it will end coverage for physicians in the Mount Sinai system. UnitedHealth hasn’t been paying Mount Sinai providers as much as providers at other hospital systems.

    What can you do if your health care providers leave your insurers’ networks? You have some protection against surprise medical bills. And, your insurer is obligated to have adequate networks, so your insurer might continue to cover your care in order to meet network adequacy requirements. But, this is no way to run a healthcare system if you care at all about patients’ health and well-being.

    Here’s more from Just Care:

  • Plan ahead: Who will pay your bills if you cannot

    Plan ahead: Who will pay your bills if you cannot

    If you’re like most people, you are going through life doing your best to manage your bills, without thinking about who will pay them on your behalf if you are not able to. But, the last thing you want on top of the medical bills you’ll accrue if you are hospitalized or need rehab care is a collection agency coming after you. So, it’s wise to plan ahead, get your affairs in order, and appoint someone you trust to pay those bills through a durable power of attorney.

    A durable power of attorney is a legal document that allows you to name someone to help with your financial affairs whenever you would like, including if you become unable to handle them yourself. The person you name should be someone you trust with your finances, someone who could make decisions about your finances if need be. That person also could be your health care proxy or health care buddy.

    Why should you give someone a durable power of attorney? Giving someone you trust a durable power of attorney should give you peace of mind that your affairs will be taken care as you would like, if you cannot take care of them. Without a durable power of attorney, the person you would want to handle your financial affairs would have to go through an expensive and lengthy court proceeding to make these decisions. Moreover, without the durable power of attorney, a judge might appoint someone you do not trust to handle your affairs.

    How long does a durable power of attorney last? The durable power of attorney lasts until you die or until you change it.

    What is the difference between a durable power of attorney and a power of attorney? If you give someone a power of attorney rather than a durable power of attorney, then the person you designate only has authority over whatever financial matters you specify until you become mentally incompetent. But, if you choose, you can make the power of attorney document a durable power of attorney. You need only include language in the power of attorney that specifies that the person you designate has authority if you become mentally incompetent. Unless you make the power of attorney a durable power of attorney, the person you designate cannot handle your financial affairs if you become mentally incompetent.

    Who should have a copy of your durable power of attorney? You should give a copy of the durable power of attorney to all financial institutions at which you have accounts. And, you should give a copy to the person you name to have your durable power of attorney or, at the very least, let that person know he or she has that authority and where to find the document if needed.

    If I give someone a durable power of attorney, will that person be able to take money from my bank accounts? Yes. The person you name as having durable power of attorney, your financial agent, will be able to take care of your financial affairs using your bank accounts if you give the person that authority. But, this agent does not own the money in your accounts and may not take money from your accounts for himself or herself.

    What should I discuss with the person I name as having durable power of attorney?  You should let your agent know about all institutions with which you have financial arrangements, including your banks, credit card companies, financial advisors and insurance companies.

    Can I cancel my durable power of attorney? You can cancel or change your durable power of attorney at any time by destroying it and notifying the financial institutions at which you have accounts that you have destroyed it or changed it.

    Is there anything more I need to do? Yes! You should be sure to let the person to whom you give your durable power of attorney know and you might want to let other people you trust know that this person has durable power of attorney. You also need to let your bank know about your durable power of attorney. You also need to pull together a list of the bills you pay, your checking account information, and other information needed to make sure your bills are paid and have that available to the person to whom you give your durable power of attorney. Click here for a checklist.

    Here’s more from Just Care:

  • Hospital billing practices frequently leave people without medical care or in court

    Hospital billing practices frequently leave people without medical care or in court

    The Lown Institute reports that if you aren’t able to pay your hospital bills, you have a one in three chance of being sued. On top of that, some hospitals are refusing to allow you to schedule new appointments.

    Almost half of adults in the US find affording the cost of healthcare challenging. Forty percent of them have medical debt. And, many of those people in debt end up choosing to go without medical care or to leave the hospital against medical advice. Medical debt now totals somewhere between $81 to $140 billion.

    The Lown Institute is collecting information on each hospital’s billing and collection practices. People should know which hospitals to avoid. That said, many hospitals are struggling to survive. There’s no excuse for hospitals filing lawsuits against patients, but the hospital system is broken. And, there’s also no excuse for the government standing back and watching hospitals go bankrupt because insurers are not paying them, to the detriment of their constituents.

    The Leapfrog Group, Northwestern University Feinberg School of Medicine, and Johns Hopkins University School of Medicine published a recent analysis of some hospital billing and collection data in JAMA. Of the more than 2,000 hospitals studied, a third said that they bring lawsuits against patients for delayed or inadequate payment of their bills. Rural hospitals sue patients more frequently than urban and suburban ones.

    What’s equally appalling is that hospitals often do not provide patients with itemized bills within a month of services. And more than one in 20 hospitals surveyed had no representatives to help patients with billing questions or to look into billing errors or to set up a payment plan.

    What is to be done? Lown does not propose national health insurance, likely because it’s not on the table at the moment. It should be. That’s the only way to ensure health equity and end medical debt. It’s also a far better way to ensure hospital solvency than allowing hospitals to sue patients for money they don’t have.

    Lown is focused on better hospital billing practices. Insanity. Who could step in to ensure that hospitals did a better job of billing patients? The JAMA authors say that if we standardized hospital billing practices, there would be greater accountability. Good luck! At the very least, we should be standardizing hospital prices.

    We should not leave it to the states to fix this problem. They do not have the will, the skill, the money or the power to take this on. Yes, a couple of states have done a little on credit reporting of medical debt. That’s something, but not wildly enough. How many millions more people will suffer the indignity of not being able to get medical care or of not being able to afford medical care or of being sued for not being able to pay medical bills before Congress acts?

    Lown Institute suggests that documenting the problem could help promote health care affordability and hospital accountability. By the time they have the data they need and anyone’s attention, tens of millions of Americans will have been harmed by our travesty of a healthcare system.

    Here’s more from Just Care:

  • Some hospitals gouge Americans because they can

    Some hospitals gouge Americans because they can

    One of the many benefits of Medicare is that your costs are the same no matter where you get care in a community. Consequently, people with Medicare do not have to “shop” for where they get care in order to keep their costs down. But, as Bloomberg News reports, some hospitals gouge non-elderly Americans because they can; people can reduce their costs only if they are willing to “shop” for where they get their care.

    Our health care system should not encourage shopping for health care. Everyone in a given region should pay the same price. Otherwise, people who need care urgently, people with cognitive conditions, people who cannot drive long distances, among others, could be forced to forgo needed care or to pay a premium to get that care. Moreover, since the cost of hospital services is generally not bundled and rarely do people know the range of services they will need, it’s near impossible to know whether the whole bundle of costs will be lower at one place or another.

    Bloomberg News describes how one woman, who was in labor, drove 45 minutes to get to a hospital that would charge her less to deliver her baby. It  saved her “thousands of dollars.” Her total cost was $8,354 and she was responsible for $2,500. But, had she gone to a hospital closer to home in Monterey County, the cost for delivery of her baby could have been as much as $40,000.

    Throughout the US, some hospitals charge a lot more than other nearby hospitals. And, there is no correlation between higher hospital prices and better quality care. But, high hospital costs drive up health insurance premiums.

    In 2023, Americans spent $4.5 trillion on health care. A lot of that money goes to hospitals.

    As a result of recent legislation, hospitals must post their prices for public review. But, is that enough? And, what explains the large price disparities within a region?

    While high hospital costs can stem from high staffing or maintenance costs or the simple ability of hospitals to set their prices as they will, some hospitals charge some insurers way more for their services than others because some insurers deny a lot of their claims or otherwise require them to expend more resources to get patients the care they need.

    Today, according to Rand research, companies pay more than double what Medicare pays for the same services. In Indiana, companies pay almost three times what Medicare pays.

    Hospital prices are likely to continue to rise at an unsustainable rate if the government does not step in. Meaningful hospital competition is lacking. Ninety-six percent of hospitals are in non-competitive markets. MedPAC, which oversees Medicare payment and quality issues, recommends that Medicare continues to put financial pressure on hospitals to keep costs down.

    Here’s more from Just Care:

  • For-profit hospitals urge CMS to hold Medicare Advantage plans to account for wrongful denials

    For-profit hospitals urge CMS to hold Medicare Advantage plans to account for wrongful denials

    Over the last several decades, US hospitals, particularly the for-profit hospitals, generally have not been the best of allies with the organizations representing people with Medicare and other Americans. But, when it comes to Medicare Advantage, the hospitals continue to speak out vociferously against corporate health insurers for delaying and denying critical treatment and failing to pay the hospitals appropriately for the care they deliver. The Federation of American Hospitals, which represents the for-profit hospitals, is now asking the Centers for Medicare and Medicaid Services (CMS) to evaluate Medicare Advantage plans based on how frequently their prior authorization denials are overturned, reports Rylee Wilson for Becker’s.

    The star-rating system for evaluating Medicare Advantage plans is a farce. Medicare Advantage plans with five-star ratings could still have high denial and delay rates. The system misleads people. The star-rating system should be an important measure for assessing Medicare Advantage plans. If CMS’s star-rating system gave substantial weight to Medicare Advantage plan denial and delay rates as well as overturn rates for prior authorization denials, it could help warn people about poor performing health plans.

    The Federation of American Hospitals shared its proposal to CMS with Becker’s but does not appear to have posted it online. It argues that adding prior authorization denial overturn rates as a measure in its Medicare Advantage star-ratings system “will enhance CMS’s oversight of MA plans’ denial of prior authorization and payments and provide beneficiaries with needed insight to inform their decision-making.”

    Of course, adding prior authorization denial overturn rates as a measure is only as valuable as the data CMS collects is accurate and timely. Right now, CMS does not get complete, accurate or timely data from the Medicare Advantage plans. Without a complete overhaul in how CMS collects data–prior authorization denials should go to CMS at the same time as they go to providers–it’s not clear that this new measure will help Medicare enrollees or enhance CMS oversight.

    The Medicare Payment Advisory Commission reports that 80 percent of prior authorization denials were ultimately approved on appeal in 2021. The Federation of American Hospitals argues that this high overturn rate shows that insurers are “intentionally” denying and delaying needed care.

    Many members of Congress are also concerned about prior authorization denials and want MA plans to report more data.

    Because insurers know that they can maximize their profits through delays and denials of care and coverage and can do so with near impunity, it appears that inappropriate delays and denials are on the rise. And, hospitals are cancelling their contracts with MA insurers to protect themselves and their patients. CMS has not addressed this issue effectively to date.

    People enrolled in Medicare Advantage plans should beware, especially given the likelihood that they will face these obstacles to care when they develop a complex or costly conditions.

    Here’s more from Just Care:

  • Underpayments lead hospitals and specialists to cancel Medicare Advantage contracts

    Underpayments lead hospitals and specialists to cancel Medicare Advantage contracts

    Ken Alltucker reports for USA Today on how insurers offering Medicare Advantage plans are underpaying hospitals and specialists. Consequently, these health care providers are dropping their Medicare Advantage contracts. It’s hard to see how this persisting issue can be solved given the corporate health insurers’ ability to use their own proprietary claims processing software, which makes oversight near impossible.

    Since Medicare Advantage plans legally must cover the same benefits as Traditional Medicare, they should be required to to use the same claims processing software as Traditional Medicare to ensure they do. They should also be required to pay hospitals and specialists the same rates as Traditional Medicare.

    Traditional Medicare rates are significantly lower than commercial insurance rates because, unlike Medicare, which uses its enormous leverage to set fair rates with providers, commercial health insurers are generally unwilling or unable to negotiate low rates for people under 65. But, Congress allow Medicare Advantage insurers to pay providers even lower rates than Traditional Medicare. So, the insurers sometimes will only pay lower rates; consequently, they can keep top quality providers out of their networks and increase their profits. Narrow networks keep people with costly conditions from enrolling or remaining in a Medicare Advantage plan.

    The USA Today story feeds off of other stories in Becker’s Hospital, MedPage Today and Kaiser Health News, documenting the financial problems and patient safety concerns that hospitals are dealing with because Medicare Advantage plans are undermining their ability to provide good patient care and underpaying them. When these hospitals cancel their Medicare Advantage contracts, tens of thousands of patients face major care disruptions.

    The patient care disruptions mean that patients need to find new doctors and hospitals or pay out of network to continue to get care from the same providers. The Centers for Medicare and Medicaid Services, which oversees Medicare, can step in to help patients when there are “significant network changes,” but it is not clear how often or whether it ever does.

    It’s likely that the disputes that USA Today documents are the tip of the iceberg. Even when Medicare Advantage plans agree to pay decent rates to hospitals, they can and do often refuse to pay the hospitals and other care providers what they owe them, cutting payments by as much as 30 percent. Hospitals then report losing tens of millions of dollars in revenue, while the insurers run away with the store. Moreover, hospitals also report inability to provide timely and necessary care to their patients in Medicare Advantage plans.

    The Medicare Advantage payment system is defective. The government pays the insurers upfront regardless of how much they spend on care. The government is not even able to monitor how much the Medicare Advantage plans spend on care effectively, in order to ensure enrollees are getting the benefits to which they are entitled. Not surprisingly, the Office of the Inspector General has found widespread and persistent failure on the part of the health insurers to pay for medically necessary care they should be paying for and that Traditional Medicare covers. That’s one way that the insurers profit.

    St. Charles Health system in Oregon tried and failed to resolve its disputes with insurers offering Medicare Advantage. As a result, it is cancelling contracts with Humana, HealthNet and WellCare. Its chief clinical officer said that unless it cancelled these contracts, their physicians would face restrictions on “patient care, longer hospital stays and administrative burdens.”

    Here’s more from Just Care:

  • 200,000 UnitedHealth enrollees in North Carolina likely losing coverage

    200,000 UnitedHealth enrollees in North Carolina likely losing coverage

    The University of North Carolina (UNC) Health is planning to end its contract with UnitedHealth because it is  “not negotiating with us in good faith.” Two hundred thousand people enrolled in UnitedHealth’s North Carolina plans are likely to lose their access to UNC Health, reports MedPage Today. As more and more hospital systems throughout the country face health insurer prior authorization delays and denials, denials of payments and other financial and administrative burdens, people are at serious risk of care disruptions.

    If UnitedHealth doesn’t meet UNC’s needs, tens of thousands of people in UnitedHealth’s Medicare Advantage plan in North Carolina will lose access to UNC hospitals and providers effective April 1, 2024. They are not alone. Equally concerning is that many smaller and rural hospitals are closing as a result of UnitedHealth and other health insurers failing to pay them appropriately.

    UNC Health’s chief clinical officer Matthew G. Ewend, MD says that UNC needs to hold UnitedHealth accountable for underpayments and undermining patient care. UnitedHealth is not prioritizing patient health and well-being. He says, “UnitedHealthcare improperly denies claims and causes unnecessary delays in patient care. This can negatively affect your well-being.”

    Since now is open enrollment season, UNC is urging its patients to find a new insurer rather than face disruptions in care in 2024. John Buse, MD, director of the UNC Diabetes Care Center, said “We need a single-payer healthcare system! The incentives are all wrong.” He is so right.

    So long as insurers profit from delays and denials of care and coverage, they will continue to delay and deny care and coverage inappropriately. Unfortunately, it seems that neither the states nor the federal government have the will or the power to hold them accountable for their bad acts. A review of enforcement actions by the Centers for Medicare and Medicaid Services against Medicare Advantage plans in 2023 reveals not a single enforcement action.

    Here’s more from Just Care:

  • Rural hospitals accept Medicare Advantage at their peril

    Rural hospitals accept Medicare Advantage at their peril

    Sarah Jane Tribble reports for Kaiser Health News that small rural hospitals have been hit hard by Medicare Advantage.

    The CEO of Battle Mountain General Hospital, in a Nevada gold mining town, turned away Medicare Advantage plans for the last few years. The Medicare Advantage plans weren’t willing to pay his hospital as much as traditional Medicare pays. And, the Medicare Advantage plans have yet to come forward with a fair offer.

    Consequently, people in the town of Battle Mountain can’t sign up for Medicare Advantage unless they are prepared to drive three hours to Reno or four hours to Salt Lake City to go to the hospital or they are willing to pay out of pocket for their local hospital care.

    Hospitals across the country, small and large, say that at times the insurers don’t pay them or don’t pay them promptly, putting them at financial risk. More than 150 rural hospitals have closed. The largest number of hospital closures have been in Texas, Tennessee and Georgia. Even though Medicare calls these rural hospitals “critical access,” the government has not ensured their ability to continue or protected them against the threat of Medicare Advantage payment denials.

    Dozens of hospital systems are cancelling their Medicare Advantage contracts because of patient safety concerns as well as inappropriate delays and denials of payment, forcing their patients to find new health care providers. Still, in rural America, enrollment in Medicare Advantage continues to grow at a rapid pace since 2010.

    What’s noteworthy is that the government pays these hospitals more in traditional Medicare because they are designated as “critical access.” Since government payments to Medicare Advantage plans are based on payments to providers in traditional Medicare, it appears that Medicare Advantage plans are the ones benefiting from these additional payments. They are pocketing the extra money, not willing to pay the hospitals the same rates as traditional Medicare pays.

    But, some rural hospitals have no choice but to accept the terms the Medicare Advantage plans offer them. Too high a percentage of their patients are enrolled in Medicare Advantage. Mesa View in Nevada, for example, has 21 Medicare Advantage contracts. But, the hospital can’t get the MA plans to pay for the care they provide enrollees. Mesa View is now owed more than $800,000 for care it has provided.

    Not only are the insurers that offer Medicare Advantage plans hurting the rural hospitals with which they are contracting, they are hurting the patients who most need care. These patients have to travel long distances to get their nursing care and rehab care covered. The local providers won’t take Medicare Advantage because they are not paid appropriately to treat them. They only take Traditional Medicare patients.

    Some Medicare Advantage plans appear to pride themselves on saving money and maximizing profits by hurting provider finances and keeping people from getting easy access to care. Meanwhile, according to Kaiser Health News, ‘Centers for Medicare & Medicaid Services press secretary Sara Lonardo said CMS has acted to ensure ‘that private insurance companies are held accountable for providing quality coverage and care.’” I have been trying to determine what CMS is doing to ensure accountability from the corporate health insurers offering Medicare Advantage for years now; if CMS is doing anything meaningful, it is far from evident.

    In response to a bi-partisan Senate letter to CMS about ensuring MA pays health systems appropriately, the CMS administrator claimed a final rule issued in April addresses concerns about MA coverage rules. She makes no mention about inappropriate MA payment delays and denials.

    Here’s more from Just Care: