AT THIS HOUR

July 8, 2022

$100: The per member per day fine health plans will now face if they do not post the negotiated rates they pay to in-network providers and potential out-of-network billable amounts patients may owe, due to a new regulation that went into effect last Friday. Though hospitals have been slow to post their prices since that transparency rule went into effect, the much larger potential fines health plans face seems to be having the desired effect. Many large plans, including United Healthcare, have already posted the required information. But even full health plan compliance won’t automatically give consumers the information they need. The required format for this data – machine-readable files – is almost impossible for most consumers to interpret.

Not So Stranger Things: In a poll we did of 12,107 teens 13-18 years old, 64% said their favorite TV show is Stranger Things, 53% said their favorite sport is probably Pickle Ball, and less than 2% said they want to be a doctor or nurse when they grow up. So much for solving the clinician shortage, but at least this generation will know how to conquer zombies and hit plastic balls.   

Predictive Health: Memorial Hermann and genomics company Helix are partnering to give 100,000 people genetic data intended to help them and their providers assess risk for serious health conditions such as cardiovascular disease and certain cancers.

Costly Screens: While most preventive screenings are free to patients, those whose screenings turn up issues that need further diagnostics often find themselves responsible for hundreds or thousands of dollars in copays. Recent research published by the University of Michigan’s Center for Value-Based Insurance Design uncovered average costs for people who needed additional testing after preventive cancer screening: $152 for further imaging or biopsies after mammograms, $155 for a biopsy after a suspicious result on a cervical cancer test, $100 for a colonoscopy after a stool-based colorectal cancer test; and $424 for follow-up tests after a CT scan to check for lung cancer. Blue Cross NC recently came out with a policy that will remove copays for one of these situations. As of June, the health plan covers 100% of screening colonoscopies after a positive stool-based or direct visualization test. 

Reimbursement Cuts: Two midwestern Blues are cutting rates. In September, BCBS Nebraska starts to apply Medicare’s multiple procedure payment reductions for therapy and radiology procedures and payment for any procedure submitted with modifier 52 will be reduced by 50%. BCBS Michigan will also begin applying a multiple procedure reduction for PT, ST, and OT in October. The plan announced the change will result in an average reimbursement of 83% of the allowed amount for all subsequent therapy services done on the same day. 

Speak Your Mind: Spoken language patterns can predict with 93% accuracy if a person is at risk for psychosis, a symptom of Schizophrenia, and if the condition will progress within 2 years, a National Institute of Health study has found.  

Extra Point: When our youngest Tommy was just about two his pediatrician said he wasn’t saying words because his tongue was tied, so Dr. Leo referred us to a specialist who had fancy degrees on his wall. Tommy laid back in the dentist-type chair and the doctor, an ENT by training, took out what I swear was a pizza cutter, plugged it into the wall, took an uncomfortably long deep breath and with Tommy screaming bloody murder and my right hand holding down Tom’s shoulder, the doctor went in. He cut the “tie” and some blood emerged after maybe 6-7 seconds he pulled the cutter back, turned to me and said “What do you think?”  What do I think!?  I couldn’t believe that the ENT-trained doctor with the fancy degrees was asking for MY medical opinion. I get it, he wasn’t asking me to diagnose cancer, but still.  I breathed, shrugged a bit and said “Well doc, I think we can keep going, let’s get a bit more of it.”  I couldn’t believe I said it and if you could have only seen my bride’s face in that moment.  So doc nodded, re-engaged that pizza cutter and went back in, cutting “a bit more” of that tie and, well, within a few days Tommy was speaking. And now some 13 years later says all sorts of words, some of the bad ones that George Carlin told us we can’t say on television, and some good ones too, like precipitous and incandescent and his latest thesaurus classic, ephemeral, which to be honest I had to look up. It apparently means things that don’t last forever, like conversations or arguments or those moments when your kids are little and you have no idea what you’re doing, hold on for dear life, cherish a good hot meal, and hope to God you don’t screw them up too much.