@HLPI_UHLC 1/ Frankly surprised at this article’s lack of substance beyond the basics—not to mention several of their statements which are either unsupported by data or experience.
1.Authors claim that the NSA will likely have little impact on physicians who do not engage in SMB....
@HLPI_UHLC 2/ —that’s not what the CBO thinks per their scoring of the E&C bill;

2.Outside of the biased studies out of Georgetown by the policy institute funded by the founder of Wellpoint health plan, there is not objective data that either the NY or NJ SMB models are inflationary.....
@HLPI_UHLC 3/ in fact, the NY DFS noted in their report in 2019 that folks there have saved over $400M—how is that inflationary?

3.Authors clearly like the CA model of benchmarking with no reference at all to the surveys done by the CA medical association of its members......
@HLPI_UHLC 4/ and the disastrous impacts benchmarking has had in Cali. #SMB #Surprisemedicalbilling #NSA

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More from @EdGainesIII

21 Dec 20
1/ In the "section by section" summary, several key #SMB changes from the 12/11/20 draft appear to have been made (subject to seeing leg. language): 1. the median in network rate must be "market based" instead of unilaterally determined by the health plan (++); 2. gov't payors...
2/ "public payor rates" cannot be considered by the adjudicator, & not charges (that was in the earlier draft); 3. Not sure if the tech. issues w/ claims that occur during the IDR being eligible for the next IDR were addressed--seems like they're trying to there; 4. stay tuned
3/ "trying to get there"... if I had a nickel for every typo in the past month....
Read 11 tweets
11 Dec 20
1/ Ranking Minority Brady is supposedly meeting w/ W&M chair Neal in the am as a "Grand Bargain" is perhaps coming together after pressure from @SpeakerPelosi on #SMB--w/ no legislative language socialized 2 anyone in the doc community--2 of 4 corners in Senate remain opposed.
2/ Let's bolster the oppo w/ the simple message that we don't sign off on deals where there's no language + how about the bills that physicians passed in #NY #TX & #GA tens of millions of Pts are out of the middle due to physician lead bills--don't suggest "we're the party of no"
Read 7 tweets
1 Dec 20
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.......
3/ #TX model is working while not perfect for either side--costs for IDR are split and not loser pays but no law is perfect--TX continues to get an "A" @Reese_Tassey @drdanchoi @sonodoc99 @ercoderguy @amychomd @fuzzymittens @mass_marion @Valleus556 @TexACEP @szaafran ImageImage
Read 4 tweets
9 Nov 20
@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....
@sonodoc99 @mssnytweet @CNBC @pfizer 3/ big thx to @BeckyQuick for expressing the emotions of tens of millions of your fellow citizens—the biggest & best news of the year!
@sonodoc99 @mssnytweet @CNBC @pfizer @BeckyQuick 4/ @pfizer CEO says that the @US_FDA will review the detailed safety data next week + he received the phase 3 results Sunday Nov. 8th about 2pm
Read 5 tweets
24 Sep 20
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
Read 5 tweets
22 Sep 20
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
Read 5 tweets

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