1/ 👉 “After careful consideration and given the significant concerns set forth...⁦@AmerMedicalAssn⁩ respectfully urges the @TheJusticeDept to conduct a thorough examination of the antitrust ramifications of UHG/Optum’s proposed acquisition of CHNG.” tinyurl.com/e2nfztbr
2/ @AmerMedicalAssn writes:

“There is substantial overlap in markets for health information technology (IT)/analytics services that the merging firms supply to health insurers, physicians, and hospitals.”
3/ “Given this overlap and the companies’ large sizes, it is likely that the merging firms have been, or absent the merger would become, substantial head-to-head competitors.”
4/ “The loss of such competition or potential competition could have significant anticompetitive effects on physicians, hospitals, and health insurers.”
5/ “Moreover, the acquisition could also have vertical anticompetitive effects in health IT/analytics, health insurance, physician, and clinical guideline markets.”

“The effects on clinical guideline markets could particularly harm consumers through reduced quality of care.”
6/ AMA notes the merger:

•Involves companies that are large players in Health IT/Analytics and vertically related markets

•Is a horizontal merger that could cause loss of substantial/potential head-to-head competition

•Has vertical ramifications

•Raises physician concerns
7/ Here are a few of the points in the excellent letter by AMA:

“OptumInsight serves nine out of ten U.S. hospitals and more than 100,000 physicians...reports having access to ‘clinical and claims data’ for 250 million insured lives...serves four out of five U.S. health plans.”
8/ Per Change HC, it provides solutions supporting
~2.4K government & commercial payer connections, 1 mil physicians, 125K dentists, 39K pharmacies, 6K hospitals & 700 laboratories...clinical records for over 85 mil unique patients, ~1/4 of the estimated total U.S. population.
9/ “Acquisition of large data stores could enable UHG to harm physicians as it has in the past.”
10/ “Physicians regard the Ingenix case as a cautionary tale about the threat to physicians when third-party payers gain access to large amounts of physician/patient data without express consent.”
11/ “...the 2020 MITRE report states that deidentified data provided by CHNG alone represented more than 50% of private insurance claims in the U.S.”
12/ “...in addition to purely administrative exchanges, CHNG’s Intelligent Healthcare Network also facilitates the exchange of clinical records for ‘over 85 million unique patients, approximately one-quarter of the US population.’”
13/ “OptumInsight alone reports access to ‘clinical and claims data’ for ~250 million insured lives.”

“The acquisition will result in payer control of clinical guidelines, which could harm patients by creating barriers or disruptions to care.”
14/ “With the acquisition, InterQual clinical guidelines will fall under the complete control of the parent company of the largest health insurer in the country.”
15/ @AmerMedicalAssn reviewed this transaction from its “long-standing perspective that competition in health care and related markets is the right prescription for these markets.”
16/ @AmerMedicalAssn writes:

“The purpose of this letter is to identify potential antitrust concerns and to encourage the @TheJusticeDept to conduct a thorough examination of the proposed acquisition.”

👉 Read the letter here: tinyurl.com/e2nfztbr

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More from @MarilynHeineMD

17 Mar
1/ @AmerMedicalAssn⁩ strongly supports HR1868 to protect physician practices: tinyurl.com/tna2a8hk

Prevent across-the-board direct spending cuts that threaten financial viability of physician practices, especially during #COVID19 PHE & beyond. @SpeakerPelosi @GOPLeader
2/ HR1868 is vital to protect physician practices:

•Extend current moratorium on the 2% Medicare sequester cuts past the 3/31/21 deadline

•Avoid additional Medicare statutory PAYGO cut of up to 4% triggered by budgetary impact projected under American Rescue Plan Act of 2021
3/ The #COVID19 #pandemic persists and continues to have a substantial fiscal impact on physician practices.

It is critically important that physicians are able to provide frontline care to #Medicare beneficiaries.
Read 12 tweets
15 Mar
1/ Take care to not run afoul of #HIPAA. Lest you risk penalties and jeopardize the patient-physician relationship.

“Protecting information gathered in association with the care of the patient is a core value in health care.” tinyurl.com/45rk8hr4 ama-assn.org/practice-manag…
2/ The Code of Medical #Ethics also states, “However, respecting patient #privacy in other forms is also fundamental, as an expression of respect for patient autonomy and a prerequisite for trust.”
3/ Physicians and hospitals may share patient information without explicit patient consent for treatment, payment, business operations.

@HHSOCR enforces #HIPAA. Voluntary compliance and corrective action without a fine is a goal, but penalties are steep for “willful neglect.”
Read 8 tweets
15 Jan
1/ @AmerMedicalAssn⁩ applauds
decision by ⁦@HHSGov⁩ to allow physicians to prescribe #buprenorphine without an X-waiver for the treatment of patients with #opioid use disorder. #OUD

However, it is important to keep in mind several considerations: ama-assn.org/press-center/a…
2/ •Use of #buprenorphine by a person who has #OUD but is not in withdrawal can precipitate withdrawal. This is a significant adverse experience. It also dissuades patients from adherence to treatment.
3/ •It is unclear whether removal of the X-waiver requirement for #buprenorphine-prescribing will increase access to care in the community. Already, physicians who have an X-waiver do not see the full allowed complement of patients who have #OUD.
Read 12 tweets
9 Jan
1/ @HHSGov⁩ ⁦@SecAzar⁩ has extended the #COVID19 Public Health Emergency (PHE) declaration effective Jan. 21, 2021 for an additional 90 days.
2/ This means that all of the #telehealth and other waivers and flexibilities that have been implemented during the #PHE will remain in effect until at least April 21, 2021.
3/ As in the summary & impact table by @AmerMedicalAssn, the Consolidated Appropriations Act signed into law 12/27/20 included provisions that offset most of the 10.2% budget neutrality adjustment that was slated to take effect for Medicare-covered services provided as of 1/1/21.
Read 8 tweets
9 Jan
1/ Check out this detailed summary by AMAzing ⁦@AmerMedicalAssn⁩ advocacy staff:

•Select provisions of the Consolidated Appropriations Act, a comprehensive omnibus spending package

•AMA table of #Medicare physician impact broken down by specialty ImageImage
2/ Dec. 22, 2020, the President signed into law the Consolidated Appropriations Act, 2021 that:

•Funds the federal government through FY 2021,

•Provides a new round of #COVID19 relief and economic stimulus, and

•Imposes new restrictions on #SurpriseMedicalBilling.
3/ For an @AmerMedicalAssn summary of select provisions in the Consolidated Appropriations Act, please see here: tinyurl.com/y65utfno
Read 13 tweets
9 Jan
1/ @AmerMedicalAssn⁩ led a sign-on letter with over 100 national specialty and state medical societies submitted to ⁦@DeptVetAffairs⁩ in opposition to its recent Interim Final Rule (IFR), “Authority of VA Professionals to Practice Health Care.”
2/ The @DeptVetAffairs IFR permits virtually all VHA-employed non-physician practitioners (NPPs) to practice without the clinical supervision of physicians and without regard to state scope of practice law.
3/ The IFR establishes the VA’s authority to allow virtually all NPPs to practice without the clinical supervision of a physician. In doing so, the IFR preempts state license, registration, certification, supervision, or other requirements.
Read 5 tweets

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