Tag: Healthcare

DOJ Argues ACA Pre-existing Condition, Individual Mandates Unconstitutional

DOJ Argues ACA Pre-existing Condition, Individual Mandates Unconstitutional | DAS Health

The Department of Justice on Thursday night declined to defend the Affordable Care Act in the U.S. District Court for the Northern District of Texas, instead filing a brief arguing that broad swaths of the law, including the provision compelling payers to cover those with pre-existing conditions and the individual mandate, are unconstitutional.

The brief argues the Supreme Court upheld the constitutionality of the individual mandate on the basis of the penalty being considered a tax. With Congress zeroing out the penalty starting in 2019 in the Tax Cuts and Jobs Act, the individual mandate, community rating and guaranteed issue provisions of the Affordable Care Act cannot stand, DOJ said.

The case probably will not be resolved this year, with the District Court decision likely to be appealed first to the 5th Circuit Court of Appeals and then to the Supreme Court.

DOJ’s decision is the latest in a slate of moves by the Trump administration aimed at weakening the Affordable Care Act, after failing to repeal it in Congress. Payers now face even more uncertainty as they set premiums for 2019.

Other efforts by the administration, including rulemaking around short-term, limited duration health insurance and association health plans are likely to be finalized soon.

“Although Plaintiffs speculate as to a chain reaction of failed policymaking that could occur once the individual mandate is struck down, they cannot show that striking down the individual mandate, guaranteed-issue, and community-rating requirements means that the Affordable Care Act necessarily ‘ceases to implement any coherent federal policy,’” DOJ writes.

The insurance lobby, America’s Health Insurance Plans, said that it will file an amicus brief that opposes the GOP “state plaintiffs’ request for emergency relief, and provides more detail about the harm that would come to millions of Americans if the request to invalidate the Affordable Care Act is granted in whole or in part.” The group added that 2019 premium rates are already spiking higher due to the zeroing out of the individual mandate, and that further disruption would induce more uncertainty.

“Zeroing out the individual mandate penalty should not result in striking important consumer protections, such as guaranteed issue and community rating rules that help those with pre-existing conditions. Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” AHIP said in a statement.

California Attorney General Xavier Becerra and 15 other attorneys general filed a brief opposing the lawsuit Thursday.

Uber Launches Healthcare Platform

Uber launches healthcare platform, helps patients schedule rides and healthcare providers fill appointments | DAS Health

The ride-sharing company Uber is officially launching a new platform for providers to use the app to get patients to their facilities.

The dashboard, Uber Health, allows a healthcare worker to book a ride on demand or schedule a future ride for a patient. The passenger is alerted by text or phone call with trip details.

The product has been tested by about 100 hospitals and doctor’s offices so far, according to The Atlantic.

The news may not come as a shock, but it does draw a line in the sand for competitors.

Lindsay Elin, director of federal and community affairs at Uber, told Connected Health Conference in 2016 that the company was investing in a team to work solely on healthcare.

“I’d say there are two major things driving Uber’s interest,” Naveen Rao, health innovation analyst and founder of Patchwise Labs told Healthcare Dive.

“First, they see how much Lyft has rolled up their sleeves in healthcare, so the official trigger was a simple reaction to their main competitor. Second, is they’ve been involved as an enabling partner in the non-emergency medical transport space for a couple of years now and seen the demand.”

​Companies like Veyo are targeting Medicaid and Medicare patients and Circulation is offering a platform connecting ride-share services like Uber and Lyft for NEMT.

“Healthcare has a bad reputation for long sales cycles, but the companies in this space have an incredible track record,” Rao continued. “Circulation has developed 70+ partnerships in two years, based largely on their star power and first mover status, but even smaller companies like Kaizen have gathered up a dozen customers in a year. That’s big for any startup, and it’s huge in healthcare.”

Uber is also launching an Uber Health API to enable integrations into existing healthcare products. Features include access for patients without a smartphone, billing and reporting for organizations to keep track of spending on rides and HIPAA compliance.

Ride-share partnerships for hospitals help patients get to the facility. They can help patients get the care they need and it also helps providers by capturing revenue that may not have entered the building otherwise.

Every year, 3.6 million Americans miss doctor appointments due to a lack of reliable transportation.

However, it’s questionable whether rideshare services are reducing patient no-shows. Still, using rideshares is seen as a potential means to drive down healthcare costs by a) providing rides to preventative healthcare services and b) using emergency transit less.

“Uber has helped us drastically reduce appointment cancellations. It’s great to be able to quickly request a ride with so that in need patients can make an appointment they’d otherwise miss,” Pete Celano, director of consumer health initiatives at MedStar Health, said in a statement Uber provided. “We have seen significant savings using Uber rides instead of taxis.”

One study found when Uber enters a city, ambulance use decreases by at least 7%. However, using Uber as an ambulance can put a driver in an awkward position for suddenly taking on a job they weren’t trained for.

In the NEMT space, Uber sees the $3 billion market and looks to take advantage of their name brand and past success in the space to gain market share.

The ride-sharing giant touted the service’s privacy and security for patients as a way to remove barriers to care.

“Whether it’s one ride or one hundred, the dashboard makes it easy to book, reschedule, and get a clear overview of which ride is happening when,” the website reads.

Telehealth Providers Double Down on Response Efforts for Hurricane Irma

Hurricane Preparedness Disaster Recovery | DAS Health

After telehealth providers offered up free services to victims of Hurricane Harvey last week, the telehealth community is replicating the same approach as Hurricane Irma churns through Florida.

In the wake of unprecedented devastation throughout Southeast Texas from Hurricane Harvey, telemedicine vendors like American Well, MDLive, Doctor on Demand and Teledoc offered free services for victims of the storm. Florida-based Nemours Children’s Health also chipped in with free care via the system’s CareConnect platform.

Now Florida is staring down its own disaster response with Hurricane Irma flooding parts of the states and those same vendors are again stepping in to provide support. American Well began offering services on Friday, expanding its reach from Texas and Louisiana to Florida, Georgia, North Carolina and South Carolina.

Nemours also began providing complimentary visits to families in Florida and Georgia on Friday, according to a release.

Others, like LiveHealth Online and Florida Hospital, are also offering free telehealth services. With locations in Orlando, Tampa and Daytona Beach, Florida Hospital is providing care through its eCare app that typically costs $49 per visit. MDLive, announced a partnership with AvMed, one of Florida’s largest health plans, to provide virtual visits to members in 30 counties across the state.

Meanwhile, Allscripts and Surescripts announced a collaboration to provide free access to patient-specific medication history data for pharmacists in Texas and Louisiana. Surescripts data showed a 93% decrease in prescription volume after the storm as medical providers shut down, in part because patients have trouble accessing their physician in the aftermath of a storm.

The partnership with Allscripts allows pharmacists to access a 12-month history of patient data, and a Texas state law allows pharmacists to dispense up to 30-days worth of prescriptions drugs without authorization from the prescribing practitioners.

For the first time, the American Red Cross is using drones to assess damage throughout areas of Texas and determine what geographic areas need the most aid. In a partnership with the UPS Foundation and drone manufacturer CyPhy Works, the Red Cross plans to test tethered drones as a way of prioritizing assistance to communities with the worst devastation. Officials said the pilot program will serve as a model for a rapid response team in the future that could be deployed in the aftermath of Irma.

Study: Value-Based Programs May Harm Practices That ‘Disproportionately Serve High-Risk Patients’

Value-based payment programs may financially harm practices that disproportionately serve high-risk patients.

  • A new JAMA report that reviewed the first year of the Medicare Physician Value-Based Payment Modifier (PVBM) Program found providers who served “more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.”
  • The finding led to fewer bonuses and more penalties for high-risk practices.
  • The study authors said value-based payment programs may financially harm practices that “disproportionately serve high-risk patients.”



CMS created the PVBM to measure the quality and cost of care provided to Medicare beneficiaries. The program bases payments on providers’ performance on quality and cost measures and rewards quality performance and lower costs.

The agency began to phase in practices to the program in 2015 based on 2013 performance and then planned to expand it to solo practices and later to physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists.

The study reviewed 899 physician practices with nearly 5.2 million beneficiaries that participated in the PVBM, a mandatory pay-for-performance program. Authors studied program payments in 2015 and compared them to 2013 fee-for-service (FFS) Medicare numbers.

The JAMA study’s finding that more medically high-risk patients had lower quality and higher costs is eye-opening. Those patients are usually the most costly and payment models will need to figure out ways to reduce those costs while not penalizing physicians if value-based programs are successful. A payment model that only lowers costs and improves care to healthy people won’t move the needle.

Even worse, if physicians are penalized, what incentive do doctors have to care for the sickest Medicare patients?

The JAMA report will likely not quell physician fears about how value-based programs may lead to lower Medicare payments. It also won’t satisfy individuals concerned that changes to the healthcare system may harm the most vulnerable, which is always a worry when there are major healthcare changes.

The JAMA study isn’t the first to show value-based programs as a mixed bag. Recent studies have shown that it hasn’t consistently improved outcomes and costs.

One key finding about value-based care so far has been that experience in the model plays an important role in whether a provider has success. Organizations with the most success under value-based programs have often spent years creating clinically integrated networks, James Landman, director of healthcare finance policy at the Healthcare Financial Management Association, recently told Healthcare Dive.

“If you look at the data for the Medicare Shared Savings Program, which is the biggest of the ACO programs under CMS, there is a correlation between time spent in the program and the ability to generate savings,” Landman said.

CMS is watching the results of value-based payment models like PVBM closely. The federal agency hopes to transfer 50% of traditional FFS Medicare payments to alternative payments models by next year.

CMS has slowed down the move to value-based payments, but that’s more due to the change in administration and slowly grinding gears of government than a move away from value-based programs.The federal agency has delayed the start of some programs to next year as well as paused expanding others.

Ransomware Attacks Rise, Accidental Breaches Most Common Cause of Data Loss

Hacking and malware attacks, which include ransomware attacks, continue to be the leading cause of breaches.

Unintended disclosure – such as misdirected faxes and emails – continue to drive the majority of healthcare breaches, Beazley said.

Hackers never quit. Their ceaseless assault on healthcare has continued during 2017, racking up hit after hit against provider organizations.

Ransomware attacks continued their rise in the first half of 2017, up 50 percent over the first half of 2016, according to the Beazley Breach Insights report from Beazley, a cyber and data breach response insurance firm that compares data on its base of clients from multiple industries, including healthcare.

Hacking and malware attacks, which include ransomware attacks, continue to be the leading cause of breaches, accounting for 32 percent of the 1,330 incidents that Beazley Breach Response Services helped clients handle in the first half of the year, the firm reported.

RELATED: Get better cybersecurity and protection with Managed IT Services

In healthcare specifically, unintended disclosure – such as misdirected faxes and emails or the improper release of discharge papers – continued to drive the majority of healthcare losses, leading to 42 percent of industry breaches during the first half of 2017, the report found. This was equal to the proportion of these breaches in the industry in the first half of 2016.

Hacks and malware accounted for only 18 percent of healthcare data breaches in the first half of 2017, compared with 17 percent during the first half of 2016, the report found.

Accidental breaches caused by employees making errors or data breached while under the control of third parties continue to be a significant problem for all industries – they accounted for 30 percent of breaches overall, just a bit behind the level of hacking and malware attacks.

“This continuing high level of accidental data breaches suggests that organizations are still failing to put in place the robust measures needed to safeguard client data and confidentiality,” Beazley said. “Since 2014, the number of accidental breaches reported to Beazley’s team has shown no sign of diminishing. As more stringent regulatory environments become the norm, this failure to act puts organizations at greater risk of regulatory sanctions and financial penalties.”

Unintended breaches show no signs of abating, said Katherine Keefe, global head of Beazley Breach Response Services. “They are a persistent threat and expose organizations to greater risks of regulatory sanctions and financial penalties,” Keefe said.

But they can be much more easily controlled and mitigated than external threats, she added. Organizations should not ignore this significant risk and instead put more robust systems and procedures in place, she said.

Quality Payment Program Hardship Exception Application for 2017 Now Open

Quality Payment Program Hardship Exception Application for the 2017 transition year is now available
Photo from CMS.gov

Clinicians Can Now Submit Quality Payment Program Hardship Exception Applications

The Quality Payment Program Hardship Exception Application for the 2017 transition year is now available on the Quality Payment Program website.

MIPS eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application, for one of the following specified reasons:

  • Insufficient internet connectivity
  • Extreme and uncontrollable circumstances
  • Lack of control over the availability of Certified EHR Technology (CEHRT)

There are some MIPS eligible clinicians who are considered Special Status, who will be automatically reweighted (or, exempted in the case of MIPS eligible clinicians participating in a MIPS APM) and do not need to submit a Quality Payment Program Hardship Exception Application.


About the Hardship Exception Application Process

In addition to submitting an application via the Quality Payment Program website, clinicians may also contact the Quality Payment Program Service Center and work with a representative to verbally submit an application.

To submit an application, you’ll need:

  • Your Taxpayer Identification Number (TIN) for group applications or National Provider Identifier (NPI) for individual applications;
  • Contact information for the person working on behalf of the individual clinician or group, including first and last name, e-mail address, and telephone number; and
  • Selection of hardship exception category (listed above) and supplemental information.

If you’re applying for a hardship exception based on the Extreme and Uncontrollable Circumstance category, you must select one of the following and provide a start and end date of when the circumstance occurred:

  • Disaster (e.g., a natural disaster in which the CEHRT was damaged or destroyed)
  • Practice or hospital closure
  • Severe financial distress (bankruptcy or debt restructuring)
  • EHR certification/vendor issues (CEHRT issues)

Please note: Once an application is submitted, you will receive a confirmation email that your application was submitted and is pending, approved, or dismissed. Applications will be processed on a rolling basis.


Explanation of Special Status Calculation

The Centers for Medicare and Medicaid Services (CMS) has introduced new information on the Quality Payment Program website that indicates whether clinicians have “special status” and can therefore be considered exempt from the Quality Payment Program.

To determine if a clinicians’ participation should be considered as special status under the Quality Payment Program, CMS retrieves and analyzes Medicare Part B claims data. A series of calculations are run to indicate a circumstance of the clinician’s practice for which special rules under the Quality Payment Program will affect the number of total measures, activities or entire categories that an individual clinician or group must report. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), Rural, Non-patient facing, Hospital Based, and Small Practices.

For more information, please visit the Quality Payment Program website.