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MA Governor signs new health care law.

After signing the bill on New Year’s Day, Baker said  that the commonwealth – and the nation as a whole – needs to come up with a long-term plan to make telehealth a standard of care and pay providers for its use.

“I’ve thought for a long time that because as a country we underinvest in primary care and behavioral health services a lot of people who could be treated in the community end up in the hospital and we will basically have a chance here to study this question,” he said. “I think we’ll discover that by investing more or giving people more options to access care and supports they will stay healthier and spend less time in the hospital.”

The provisions of the new law include:

Requiring coverage of telehealth services including behavioral health care

Telehealth visits became much more common during the pandemic, the new law mandates equal coverage for virtual visits, including behavioral health.

 

Expanding Scope of Practice for Advanced Practice Nurses and Optometrists

The scope of care was increased for some practitioners to help address the increased need during the pandemic. The law allows for these changes to become permanent for nurse practitioners, nurse anesthetists, optometrists, and psychiatric nurse mental health specialists. Mental health billing companies in Massachusetts are also happy about this new law.

 

Increasing disclosures around provider costs and network status to protect consumers from surprise medical bills

Among the steps to address surprise bills, providers must now tell a patient if a procedure is in network or out of network. 

 

Removing barriers to urgent care centers for MassHealth members

The new law requires urgent care to those with mass health. It also does away with referral requirements and coordinating with a patient’s primary care physician to allow easier access to Urgent Care clinics for MassHealth members.

 

Extending insurance coverage and access to COVID-19 testing and treatment

The Baker administration said the law also extends requirements for all insurance carriers in Massachusetts to cover COVID-19 testing and treatment.

The new law requires insurance companies, including MassHealth, to cover all inpatient, emergency, and cognitive rehab services related to COVID-19 care, as well as necessary outpatient testing. This includes testing for people who are asymptomatic. The law also calls for a study and report on how the pandemic affected the health care system.

 

Directing a study and report of the impacts of COVID-19 on the health care system

The legislation also directs the Health Policy Commission and Center for Health Information and Analytics to analyze and report on the effect of COVID-19 on healthcare accessibility, quality and fiscal sustainability in both the short and long term, as well as those effects on long-term policy considerations, including an examination of existing healthcare disparities due to economic, geographic, racial or other factors

 

“Massachusetts has long been a leader in ensuring health care quality and access and with this new law, we are making further progress in building a strong, accessible and affordable health care system, a goal that is more important now than ever,” Baker said

Medical Billing Outsourcing To Flourish At Double Digit between 2020–2026

A market research report published by Zion Market Research provides an insightful comprehension about the growth aspects, dynamics, and working of the global medical billing outsourcing market. The report entails details about the market with data collected over the years with its wide-ranging analysis. It also comprises the competitive landscape within the market together with a detailed evaluation of the leading players within the global Medical Billing Outsourcing Market.

In addition, it sheds light on the profiles of the key vendors/manufacturers comprising thorough assessment of the market share, production technology, market entry strategies, revenue forecasts, and so on. Further, the report will encompass the fundamental strategic activities such as product developments, mergers & acquisitions, launches, events, partnerships, collaborations, and so on. Apart from this, it will also present the new entrants contributing their part in the market growth.

The Medical Billing Outsourcing Market report also entails exhaustive examination of the key factors likely to propel or restrict the expansion of the global Medical Billing Outsourcing Market during the forecast period in addition to the most recent and promising future trends in the market. Moreover, the report uses SWOT analysis and other methodologies to analyze the numerous segments [Product, Applications, End-Users, and Major Regions] of the global Medical Billing Outsourcing Market. Furthermore, it comprises valuable understanding about the segments like their growth potential, market share, and developments. It also evaluates the market on the basis of its major geographical regions [Latin America, North America, Asia Pacific, Middle & East Africa, and Europe]. It entails quantitative and qualitative facets of the market in association to each country and region enlisted in the report.

We discussed this report with a podiatry billing company in Wisconsin, and a mental health billing provider in Minnesota and they are all hopeful that this project growth will not be hindered by the recent corona virus crisis hitting the healthcare sector.

 

Surprise medical billing efforts in corona virus stimulus package crashes

Emergency efforts to include surprise hospital billing reform in the new coronavirus relief bill has reportedly crashed. Surprise billing is a tactic used by hospitals and other medical providers to manipulate bills so that patients and insurance companies end up paying huge amounts for treatment.

Wendell Primus, senior policy adviser to House Speaker Nancy Pelosi had plans to send a proposal on surprise medical billing to Senate Majority Leader Mitch McConnell, according to four sources with knowledge of the negotiations. By Monday night, however, the effort had been rebuffed.

“There’s still work that needs to be done with the committees,” a senior Democratic aide said.

BOSTON, MA - MAY 30: U.S. Representative Richie Neal is pictured as he is interviewed by Globe reporter Josh Miller (not pictured) at the AT&T Store on Boylston Street in Boston as part of the Political Happy Hour Series on May 30, 2017. (Photo by Jim Davis/The Boston Globe via Getty Images)

Rep. Richie Neal, D-Mass., is interviewed by Boston Globe reporter Josh Miller as part of the “Political Happy Hour” series on May 30, 2017, in Boston.

 

Photo: Jim Davis/The Boston Globe/Getty Images

McConnell was not interested in including the provision, according to three Senate aides. Neal was also an obstacle to getting reform into the Covid-19 bill, said one member of Congress briefed on the talks. “The one stumbling block has been of course, Richie trying to scuttle it,” the member said.

Neal has drawn criticism for his opposition to ending surprise medical billing and his ties to Blackstone, his top funder this cycle. The progressive group Fighting Corporate Monopolies ran ads attacking Neal, during his primary against Holyoke Mayor Alex Morse, over “protecting Blackstone’s profits” by helping last year to end a Senate compromise deal that would have ended surprise billing, The Intercept previously reported. Neal pulled in major donations from Blackstone executives at the same time he went to work against surprise billing — an unusually close link between campaign contributions and congressional action. Many private equity executives are known to own vacation homes in the Berkshires, which Neal represents.

Surprise billing happens when a patient is in a hospital or medical facility that is within their insurance network but is treated, perhaps only during a single round, by a doctor who is out of network. Patients, of course, don’t know whether the doctor making rounds is in their network or not, so private equity firms have purchased providers and arranged service to maximize the number of times an out-of-network doctor can treat a patient. Those bills are then exponentially higher, landing at the feet of both patients — in the form of copays and deductibles — and insurance companies, who pay the remainder.

The ongoing coronavirus pandemic has increased the issue, with people who went to the emergency room for Covid-19 symptoms receiving surprise medical billing even when insurers have promised to cover out-of-network care related to the novel virus.

Neal tried to muscle his own version of the bill through, even though Energy and Commerce Committee had a proposal that would have relied on median-in network insurance rates to institute federal benchmarks for payment disputes. Under the proposal, bills over $750 would go to independent arbitration.

The Neal proposal would allow providers and insurance companies to settle disputes through an open negotiation process. If that fails, they could move to an independent mediation process, with a suggestion to consider the mean network rate — regardless of the size of the bill. That cumbersome process would do little to reform the system, leaving provider profits in place and potentially leading to higher premiums. Neal told reporters he wanted to punt the issue to next year, Politico reported onTuesday.

“Providers really want arbitration, because they want the ability to be able to get more money,” said one congressional aide close to the process. “Especially through private equity, because they know they can win this process. Because it almost always goes toward the provider.” 

A Ways and Means Committee spokesperson defended Neal’s bill in a statement. “The Chairman wants to find a balanced path forward on this issue that prioritizes patients but also treats fairly community doctors and hospitals that have been completely overwhelmed by the COVID crisis. He has repeatedly asked for the other committees to make the updated legislative text of their proposal public, but they have not agreed to that transparency.”

I spoke with a provider of mental health billing in Massachusetts about this and the company really hopes this issue gets resolved because it really hurts patients.

Flu vaccinations not linked to increased COVID-19 risk

According to a recent study, the flu vaccine does not increase a person’s risk of getting COVID-19 and is not associated with severe illness and death from the disease.

Doctor placing Bandaid over vaccination site
This year, the flu vaccine is more important than ever.

The research, which features in the Journal of Clinical and Translational Science, reveals that the flu vaccine is the single most important way to protect people’s health this fall and winter.

Seasonal flu activity can be unpredictable, and it is common for otherwise healthy people to be hospitalized due to critical respiratory infection each year.

Statistics from the Centers for Disease Control and Prevention (CDC) show that during the 2019-2020 United States flu season, there were 39–56 million cases of the disease. There were also 18–26 million flu medical visits, requiring up to 740,000 hospitalizations. Furthermore, flu may have caused the deaths of as many as 62,000 people in the U.S.

Preventing a ‘twindemic’

Studies investigating the 1918 flu pandemic suggest that a second wave of COVID-19 is possible in the fall and winter of 2020. This would overlap with seasonal flu’s most active phase.

Preventive measures, such as physical distancing, have also reduced the spread of the flu. The CDC reported that positive test results dropped from more than 20% to 2.3% during the pandemic and have remained at “historically low interseasonal levels.”

As the flu season merges with the COVID-19 pandemic this fall, getting the flu vaccine is more important than ever. This will help prevent a “twindemic” — the collision of flu and COVID-19.

Cleveland Clinic study

In this recent study, a team of researchers led by Dr. Joe Zein used data from individuals enrolled in Cleveland Clinic’s COVID-19 Registry. This dataset includes all individuals who underwent testing for the disease at Cleveland Clinic, not just those who tested positive.

The team analyzed more than 13,000 people who received a test between March 8 and April 15, 2020.

The investigators compared those who had received adjuvant-free influenza vaccines in the fall or winter of 2019 (4,138 patients) with those who did not receive the vaccine (9,082 patients).

An adjuvant is an ingredient that manufacturers add to a vaccine to create a stronger immune response. However, adjuvanted vaccines can cause more side effects — including swelling, fever, and body aches — than adjuvant-free vaccines.

The findings revealed no difference in COVID-19 incidence or severity between people who received adjuvant-free influenza vaccines in the fall or winter of 2019 and those who did not receive the vaccine. Both groups had a comparable risk for hospitalization, admission to an intensive care unit, and death.

“[G]etting the annual flu vaccine remains the best safeguard against the influenza virus — both for yourself and the people around you.”

Thus, researchers and clinicians believe that the population’s adherence to widespread and early flu vaccination will help reduce the risk of simultaneous viral infections and epidemics or pandemics.

Further, the study team advises people to get the flu shot because this may result in fewer people with other COVID-19-like illnesses attending doctor’s offices and emergency departments.

“We have already seen the stress that COVID-19 can put on our hospitals and resources,” says Dr. Zein. “While we’re not yet sure how flu season will affect COVID-19 susceptibility and infections, we strongly advise people to get their influenza vaccines, both for their individual health and the collective health of our care systems,” he adds.

Although the findings affirm the safety and urgency of flu vaccination, the study authors acknowledge that much remains unclear about both the disease pathology and burden to the healthcare system of having concurrent SARS-CoV-2 and flu infections.

The authors hope that other scientists will collect surveillance data in the fall of 2020 to analyze the possible outcomes of coinfection and evaluate the interaction between influenza vaccinations and any newly developed vaccine against COVID-19 infection.