Marilyn Heine Profile picture
May 27, 2022 6 tweets 4 min read Read on X
🔥A must-read: ⁦@oncologyCOA⁩ report on #PBMs

Some takeaways:

“…PBMs make up an oligopoly of rich, vertically integrated conglomerates that routinely prey on health care practices, providers, and their patients.”
2/ “PBMs have done this by overwhelmingly abusing their responsibility to protect Americans from this country’s drug pricing crisis, instead exploiting the opacity throughout the nation’s drug supply chain to enrich themselves.”
3/ “[The report] explores how the recent levels of consolidation among PBMs and health insurers is adversely impacting #cancer care, fueling drug costs, all while allowing for massive profits for #PBMs and health insurance companies.”
4/ “Examining the most pervasive and abusive #PBM tactics, each section highlights the adverse impact of PBMs on #patients, health care payers (including #Medicare, #Medicaid, employers, and taxpayers), and providers, while also detailing potential solutions.”
5/ “[Solutions] include legislative efforts at both the state and federal levels…regulators (both state and federal) have tremendous tools available to them, that up until this point, have not been widely utilized.”
6/ To read the @oncologyCOA report, “Pharmacy Benefit Manager Exposé: How PBMs Adversely Impact Cancer Care While Profiting at the Expense of Patients, Providers, Employers, and Taxpayers.” please see:
communityoncology.org/wp-content/upl…

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More from @MarilynHeineMD

Jul 30
🧵2 health IT updates

1️⃣@ONC_HealthIT⁩ ⁦@CMSGov⁩ released a Final Rule implementing disincentives for physicians & other health care providers in specific Medicare programs that ⁦@HHSGov⁩ has determined have committed information blocking.

tinyurl.com/38bkedve
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2/ The @AmerMedicalAssn created a summary brief about the new final regulation.

🗓️It is important to note that physicians and other health care providers will be subject to ONC and CMS’ disincentive regulations starting July 31, 2024. 

tinyurl.com/54csnv68



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@AmerMedicalAssn 3/ ONC has defined "#informationblocking" as any practice that is likely to interfere with the access, exchange or use of electronic health information (EHI), unless covered by an exception.

tinyurl.com/pvd76xr5
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Read 12 tweets
Jun 21
🚨🧵AMA survey indicates prior authorization (PA) wreaks havoc on patient care

Access to patient-centered care continues to suffer as health insurers

❗️Impose PA barriers on necessary care

❗️Substitute corporate policy for clinical decisions that are in patients’ best interest Image
2/🔥AMA survey shows that turmoil caused by excessive authorization controls leads to:

❗️Serious or life-threatening events for patients

❗️Unnecessary waste

❗️Physician burnout

Read:

Survey: 👇Includes health plan performance! tinyurl.com/yck5d5hs
tinyurl.com/wjrxwuzw



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3/ “Prior authorization is a blunt cost-control tactic requiring physicians to obtain approval from a health insurance company before a treatment qualifies for coverage.”
Read 18 tweets
May 21
🎇🧵Over 100 medical organizations want clarity in ⁦@Change_HC⁩ #cyberattack

⁦@AmerMedicalAssn⁩ & others want ⁦@HHSGov⁩ to affirm that ⁦@UnitedHealthGrp⁩ alone bears responsibility for notifying patients of potentially stolen #PHI. healthcarefinancenews.com/news/over-100-…
2/ “We are writing to request more clarity around reporting responsibilities and assure affected providers that reporting and notification obligations will be handled by Change Healthcare.”


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3/ “@HHSOCR should publicly state that its breach investigation and immediate efforts at remediation will be focused on Change Healthcare, and not the providers affected by Change Healthcare’s breach.”
Read 4 tweets
Apr 23
🚨🧵UnitedHealth Group (UHG) issued a press release 4/22 with more info about the Change Healthcare #Cyberattack and the impact of the breach on personal data.

UHG officials have agreed to address any additional questions from the ⁦@AmerMedicalAssn⁩ or the Federation. Image
2/ Please read the UHG press release here:

Send any questions you may have to ama.advocacy@ama-assn.org. AMA will try to get answers from UHG. tinyurl.com/2mcj4uh5
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3/ UHG’s press release states its preliminary findings from ongoing investigation & review of data involved in the cyberattack are:

a. Based on sampling of their data, files containing protected health info (PHI) or personally identifiable info (PII) were involved in the breach.
Read 12 tweets
Mar 27
🚨🧵@AmerMedicalAssn 3/26 Update on Change Healthcare cyber outage

❗️Important Survey: How has the cyber outage affected your practice? Help inform AMA advocacy for you. Deadline 3/29 tinyurl.com/9bjca2ft
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2/ On March 25, the Department of Health and Human Services (HHS) distributed these resources to assist physicians, pharmacists and hospitals, with the aftermath of the Change Healthcare #cybersecurity attacks.

👉 tinyurl.com/4pjvmpyz
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3/ AMA told HHS multiple times that physicians were having difficulty securing info from health insurers about:

-availability of assistance w/payments
-flexibilities from admin requirements
-additional contact info for troubleshooting d/t Change Healthcare cybersecurity attack
Read 8 tweets
Mar 21
🚨🧵@AmerMedicalAssn⁩ Update on Change Healthcare cyber outage:

3/19, @RepMMM @RepRobinKelly + 94 bipartisan Reps wrote @SecBecerra alerting the Admin of ongoing challenges physicians & patients continue to experience as part of the #Cyberattack.

Read tinyurl.com/3jhsssux

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2/ 🔴 The letter:

🔺Highlighted the inability of physician practices to file claims and receive payment

🔺Urged @CMSgov to clarify why they issued such stringent repayment terms for advance payments on March 9
@CMSGov 3/ 🔴 The letter also:

🔺Highlighted how many patients are being forced to pay out-of-pocket for many pharmaceuticals and health care services stemming from the cyberattack
Read 7 tweets

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