1/ New #SMB data from #TX@TexasTDI --great & timely report--hot read as follows, data from 1/1/20 to 10/31/20--a. 32,036 IDRs filed, 86% from @EmergencyDocs, 7% anesthesia & 5% other specialties; b. Settlements (after IDR is filed)--clinicians are receiving +4.43X of the ....
2/ initial health plan reimbursement; c. when the adjudicator decides the IDR, clinicians are receiving 4.74X of the initial reimbursement from the health plan. The latter figure has come down from 5.3X when the IDR is adjudicated based on the first 6 month's report.......
@sonodoc99@mssnytweet@CNBC 2/ @pfizer CEO on @CNBC said that they have 50M doses ready for ‘20 & 1.3B doses scheduled for ‘21 + no negative implications were reported yet the firm does not have visibility into the panel’s specific data set + Pt cohort ranges from 84 to 12 yrs. old....
1/ POTUS Executive Order (EO) is potentially back on & here’s the outline on the terms & conditions—the EO has been drafted—whether he announces it in the Queen's City today & that he’ll sign it is another open issue: #medtwitter 1. The prohibition on surprise medical billing...
2/ will be linked to the hospital’s conditions of participation (CoPs); 2. By law, physicians do not have CoPs—hospitals have them—so this may be an immediate potential legal argument against his actions; 3. The EO would pit hospitals against the physicians credentialed....
3/ at the hospital; 4. The concept is “network matching” & was raised during the E&C committee hearings and rejected by the committee as a solution—require that every physician group credentialed by the hospital “match” the hospital’s network of health plans; 5. The hospitals
1/ As reported in PoliticoPro –
Trump preparing executive orders on health care this week
By Susannah Luthi, Daniel Lippman, Dan Diamond
09/22/2020 02:51 PM EDT
President Donald Trump is planning to announce a series of executive actions on health care as soon as Thursday...
2/ & one EO is expected to be on #surprisemedicalbilling --been rumored for months & details are not known--last WH idea was outright ban on OON/BB w/ no mechanism for physicians & health plans to resolve $ disputes but Pts would be protected--WH COS Meadows was against ....
3/ benchmarking when he represented Asheville NC in the US House--legal authority of POTUS here very questionable as it relates specifically (but not limited to) to ACA and ERISA plans as those have specific Congressional statutes authorizing same--physicians have been approached
1/ So the #TX health plans--after supporting the solution to #surprisemedicalbilling which passed unanimously--are now pointing fingers--lets consider the facts--1. per the TX Dept. of Insurance (TDI), when clinicians informally settle their dispute before the formal dispute ....
2/ resolution process (IDR), the plans are settling for 4X of the original reimbursement paid; when clinicians go thru the IDR process, the independent dispute adjudicator is awarding >5.3X of the plan's initial reimbursement--based on TDI's report of the 1st 6 months--see charts
3/ So the original plan reimbursements are unreasonably low--one could reasonably conclude--so low that the plans are willing to pay 4X in settlement before IDR--& the Pts are protected & removed from the IDR process--the statutory factors for determining the final $ are strong
@CMSGov issued ‘21 Medicare #Physician Fee Schedule Proposed Final Rule w/ comment period & the news is not good —the Medicare “conversion factor” which applies to physicians & other clinicians is proposed to decline >10.5% in ‘21—happy reading > 1350 pgs cms.gov/files/document…
2/ Major expansion of #telehealth per the press release, details to follow.
3/ major hospital based specialists will be significantly cut in’21 by Medicare in the midst of a global pandemic—@EmergencyDocs -6%, anesthesiologists-8%, radiology -11% and IR -9%. Congress & @CMSGov here they come—Table 90, page 899.
Good luck to my good friend @lukebjensen & @nyempiretennis to take the King Trophy, doesn’t hurt to have #tennis HOF Kim Clijsters pictured here & out of retirement and crushing the ball!
How about Coach Jensens sub of Jack Sock who lit up that mixed doubles final w/ @CoCoVandey who held serve like a true champ at the end!
The Jensen’s now have a second WTT champion coach!!! Congrats buddy!! @CoCoVandey was lights out with everything on line she ripped a winner return of serve—no win by 2 here—the entire came down to 1 point.