Anesthesiologists Say UnitedHealth Unfairly Canceling Contracts
According to Modern Healthcare, the American Society of Anesthesiologists says the insurer is canceling contracts at least six months ahead of time, leaving anesthesiologists out of network and paid a fraction of the rates they once received, the group’s president says. The group wants the Justice Department to investigate.
Modern Healthcare:
Anesthesiologists Accuse UnitedHealth Of Anticompetitive Network Exclusions
The American Society of Anesthesiologists is calling on the Justice Department to investigate the “high rate” of provider contracts the nation’s largest insurer is canceling early, a practice the lobbying group says leads to higher costs for patients and employers and threatens providers’ financial viability. UnitedHealth Group’s UnitedHealthcare arm has been removing a growing number of anesthesiologists from its provider networks, the organization wrote in a letter sent to acting Assistant Attorney General Richard Powers on Thursday. (Tepper, 10/11)
In other insurance industry news —
Modern Healthcare:
Northwell Health Ditches Insurers For Direct Network Contracting
Northwell Health will provide health benefits to its 75,000 employees and dependents through a new direct contracting system at the start of the next year, the not-for-profit integrated health system announced Monday. The New Hyde Park, N.Y.-based company has expanded the partnership with Northwell Direct, a for-profit subsidiary it launched last year that eschews traditional insurers and instead uses a direct network contracting approach with providers. Northwell Health, the Empire State’s largest healthcare employer, previously had a self-insured plan administered by UnitedHealth Group’s UnitedHealthcare, and also used that insurer’s provider networks. UnitedHealthcare did not respond to an interview request. (Tepper, 10/11)
NorthJersey.com:
She’s Fought Health Insurers For Years. Now A New Jersey Girl’s Struggles Could Prompt Reform
When Pat and Dolph Geurds rushed their 7-year-old daughter to the hospital on Aug. 15, it was an all-too familiar experience. When the Geurds’ health insurer refused to pay for medication during her stay, that, too, was par for the course. Kinsley Geurds has spent a third of her young life in the hospital, her mother estimates, dealing with severe disabilities that affect multiple organs, most acutely her brain and gastrointestinal tract. Yet despite seven agonizing years of treatment and testing, the underlying cause of her illnesses remains a mystery, and that, the family said, has led to continual fights with their insurance carriers. Now, her struggles could lead to a change in state law, as legislators in Trenton, New Jersey, push to restrict insurers’ ability to delay care for children with complex medical issues. (Myers, 10/11)
And more news about the health care industry —
Stat:
Francis Collins’ Resignation Could Complicate Fight Over Funding For ARPA-H
Francis Collins’ announcement last week that he will soon step down as National Institutes of Health director could complicate the Biden administration’s plans to launch ARPA-H, arguably the largest initiative the agency has undertaken in decades. Collins, who has led NIH since 2009, is set to depart by the end of the year, leaving the White House just months to find a new leader for the $41 billion science agency. Beyond leaving the larger research office in flux, however, Collins’ retirement adds uncertainty to the process surrounding ARPA-H, a proposed $6.5 billion agency aimed at, in President Biden’s words, tackling major diseases like Alzheimer’s and diabetes and “ending cancer as we know it.” (Facher, 10/12)
The Boston Globe:
Some Dana-Farber Cancer Institute Trustees Stood To Profit From Roles
The trustees of the world-renowned Dana-Farber Cancer Institute serve a vital role. They hire the chief executive, are stewards for its thousands of vulnerable patients, organize big-ticket fund-raisers, and in some cases, give millions of dollars themselves. While the volunteer board position carries complex demands, it also puts the trustees in direct contact with the institute’s doctors and scientists who are on the front lines of the race to cure cancer. And with that, it has also given some trustees a unique opportunity for personal enrichment. (Kowalczyk, Ryley and Wen, 10/11)
Crain’s Cleveland Business:
With $18.2M Grant, Cleveland And Detroit Researchers Tackle Health Disparities
With the support of an $18.2 million federal grant, researchers at the Case Western Reserve University School of Medicine and University Hospitals Harrington Heart & Vascular Institute are leading a multi-organizational effort to address cardiovascular health disparities, according to a news release. The UH and CWRU researchers are also collaborating with colleagues at Wayne State University in Detroit on the initiative, called Addressing Cardiometabolic Health Inequities by Early PreVEntion in the Great LakEs Region (ACHIEVE GreatER). It aims to directly address social determinants of health in Black communities in the Cleveland and Detroit metropolitan areas. The grant comes from the National Institutes of Health’s P50 program, according to the release. (Coutré, 10/11)
Fierce Healthcare:
PopHealthCare Launches New National Medical Group, Emcara Health
PopHealthCare, a subsidiary of GuideWell, is launching a new national medical group that aims to offer a slew of value-based care services to payers nationwide. The new group, Emcara Health, is backed by support from GuideWell, which is also the parent company of Blue Cross and Blue Shield of Florida, or Florida Blue. The company is aiming to become a market leader in home care through its slate of services, including a 24/7 Home-Based Advanced Primary Care offering, aimed at seniors and adults. Emcara’s goal is to reduce the total cost of care by 10% to 20% without compromising on quality and patient experience. (Minemyer, 10/11)
KHN:
A Wrenching Farewell: Bidding Adieu To My Primary Care Doctor After Nearly 30 Years
I hadn’t expected the tears. My primary care doctor and I were saying goodbye after nearly 30 years together. “You are a kind and a good person,” he told me after the physical exam, as we wished each other good luck and good health. “I trust you completely — and always have,” I told him, my eyes overflowing. “That means so much to me,” he responded, bowing his head. Will I ever have another relationship like the one with this physician, who took time to ask me how I was doing each time he saw me? Who knew me from my first months as a young mother, when my thyroid went haywire, and who since oversaw all my medical concerns, both large and small? (Graham, 10/12)
Also —
AP:
California Senior Facility Fined Over Worker Abusing Woman
California regulators have fined a senior living center where a worker was secretly caught on video slapping a 90-year-old resident with dementia, roughly placing her into bed and throwing a blanket over the woman’s face. The California Department of Social Services said the treatment constituted physical abuse and fined the Brookdale Senior Living Facility in Folsom $500, saying in a report the resident sustained “a serious bodily injury while in care,” the Sacramento Bee reported Monday. (10/11)
North Carolina Health News:
Feds Put ‘Special Focus’ On 10 NC Nursing Homes
In September 2020, federal regulators determined that residents of the Lillington nursing home Universal Health Care were in “immediate jeopardy,” the most serious warning status issued by the federal Centers for Medicare and Medicaid Services, regulators announced recently. That designation became part of the reason that Universal Health Care, along with nine other North Carolina nursing homes, appears on the CMS list of the state’s worst-performing skilled nursing facilities. (Goldsmith, 10/12)
