Umbereen S. Nehal, MD, MPH, MBA’s Post

The Lower Costs, More Transparency Act (H.R. 5378) has successfully passed in the U.S. House of Representatives, enforcing greater transparency in hospital prices and extending it to clinical lab tests, giving patients full clarity on essential test prices. https://lnkd.in/gJJs7wdZ #pricetransparency #reimbursement #claims #medicalbilling

Any provider I see as a patient and/or work with as a professional colleague gets the breakdown from me lol. And not a one of them want a world where there are even fewer pharmacists and community pharmacy services available for all of their patients. Every single one of them has witnessed the decline in value and accessibility of pharmacist services and are truly afraid for when we as pharmacists aren't there to have their back so to speak. If the providers you interact with don't feel this way it's because all they know is present state of the past 6 years or so. They don't know that at a minimum we are as pharmacists supposed to function as a safety net and a collaborative provider, not "just" pill dispensers. It's on ALL of us to enlighten those providers while enlisting them in the build of wellness models which recognize pharmacists under the SSA as billing providers or alternatively start making funeral arrangements for our profession. I have found that 6 out of 10 providers aren't aware of our billing limitations either. A Dr in OT PT Nursing, Psychology etc can all bill under Medicare in addition to PAs and FNPs but pharmacists many at the doctoral level cannot bill Medicare and or many private payors independently for evaluation and management codes. We have a better safety net of CPAs in each state than almost all other mid-level providers. Yet the AMA continues to site safety concerns in blocking legislation which would provide a lifeline to pharmacies that remain to build more wellness models in support of primary care. "Pharmacies are so overwhelmed as it is blah blah" and yes because we are locked into the fee for service hamster wheel dispensing model you've and we've kept ourselves locked in over 60 years now. Please let us out so that we may save ourselves. There is a Senate bill which that hasn't moved that would add Pharmacists to the SSA and start with underserved communities, many of which are now in cities thanks in large part to PBMs. Every provider I see in some capacity learns about Senate Bill 1491 which was reintroduced last year for the second year in a row and has stalled out due to resistance and the pbm reform bills which are a band aid not a solution. https://lnkd.in/gssikvhc It's on all of us to make pharmacists providers under SSA (starting with underserved communities) a reality or start building a collective coffin for our profession. We must successfully engage all health care stake holders in order to do so. Namaste ❤️

The House recently passed the bipartisan passage of the Lower Costs, More Transparency Act in with a 320-71 vote. The bill's provisions, including delayed payment cuts for specific hospitals, showcase a commitment to equitable healthcare reform. Now headed to the Senate, the bill awaits further discussion. https://bit.ly/3RMFhAN Healthcare Dive #healthcare #payments #HealthPlans

"The Supreme Court of Appeal has dismissed an application from the medical schemes regulator to appeal against a high court directive to provide the Board of Healthcare Funders (BHF) with documents on low-cost benefit options (LCBOs), saying it has no reasonable prospect of success. LCBOs are cheap, pared-down medical scheme options that may be offered by schemes only if they are granted an exemption to the Medical Schemes Act by the Council for Medical Schemes (CMS). Proponents of LCBOs say they could potentially provide primary healthcare cover for millions of low-income workers who cannot afford traditional medical scheme options offering a greater set of benefits. "While this legal outcome is a victory for the BHF, it is essential to underscore our dissatisfaction with the apparent delay tactics employed throughout this process. These delays hinder the timely implementation of much-needed affordable medical aid options, adversely impacting [the] health [of] citizens," said BHF head of research Charlton Murove. The potential market for LCBO products ranges between 6-million and 15-million people, Murove has said. The BHF is one of SA's biggest industry associations for medical schemes. The appeal court decision, handed down on December 18, is part of a long-running legal battle between the BHF and CMS that began when the association took the regulator to court in 2022 for allegedly stalling the implementation of LCBOs. The CMS began developing a regulatory framework for LCBOs in 2015 but submitted its final report to health minister Joe Phaahla only in November 2023." https://lnkd.in/dwRbH2jN

The House just passed the bipartisan passage of the Lower Costs, More Transparency Act in with a 320-71 vote. The bill's provisions, including delayed payment cuts for specific hospitals, showcase a commitment to equitable healthcare reform. Now headed to the Senate, the bill awaits further discussion. https://bit.ly/3RMFhAN Healthcare Dive #payments #HealthPlans

The Medical Group Management Association’s annual report reveals that 90% of medical practices face an increased regulatory burden, with prior authorization, audits, and appeals leading physicians' concerns. The impact is evident, as 97% believe reducing regulatory burden would enable better resource allocation for patient care, while 77% fear it will affect Medicare patient access. Prior authorization emerges as the major pain point, with 89% finding it extremely burdensome, prompting practices to reallocate staff and causing delays or denials for medically necessary care. #healthcare #priorauthorization #mgma

Is improved palliative care reimbursement on the horizon? It could be, with the recently introduced Value in Health Care Act. This legislation aims to incentivize providers, including those in palliative care, for joining accountable care organizations and participating in value-based payment models. Several notable organizations support the passing of this bill, including the American Academy of Family Physicians, American College of Physicians, American Hospital Association, and American Medical Association. #palliativecare #valuebasedcare #alternativepayments #healthcarereform

House price transparency legislation passes with bipartisan support By Noah Tong The Lower Costs, More Transparency Act, which advances policies to force pharmacy benefit managers and hospitals to meet price transparency standards, passed on the House floor Monday by a vote of 320 to 71. The comprehensive healthcare package looked doomed several months ago, despite bipartisan support from three separate House committees, when the legislation was pulled from a vote. Support has since coalesced around the proposals, as advocates anticipate the legislation could lower out-of-pocket costs for customers. #healthcarecosts #transparency #healthbenefits https://lnkd.in/gJJs7wdZ

‘The question shouldn’t be, “do pharmacists have the ability to practice and bill for pharmacist-provided patient care services?” The question instead should be, “how soon will all payers recognize pharmacists as health care providers?”’ Thank you Dr. Michael Hogue for continuing to fight for our profession. Educating the public (and even other healthcare professionals) that the answer to the first question is already a resounding yes will hopefully lead folks to the latter question and garner more support. #TogetheRx #ForPatients #ForPharmacy #HealthcareAccess #Pharmacy #Pharmacists #TheOtherWhiteCoat

EDPMA urges Congress to stop the cuts announced by the Centers for Medicare and Medicaid Services (CMS) to reimbursements for physicians providing care to Medicare beneficiaries. CMS estimates that its proposals will result in a 3.25% reduction in reimbursements to emergency medicine in 2024. This is due to policy changes made by the Agency that it estimates will result in a 2% cut to emergency medicine and the fact that Congressional conversion factor assistance will contract by 1.25% from 2023 to 2024.    2024 will be the fourth year in a row that the Medicare Physician Fee Schedule conversion factor has contracted.  Congress must act yet again to stabilize the Fee Schedule by averting large reimbursement reductions. This is of particular urgency in emergency medicine. With EMTALA’s guarantee that every emergency patient be seen regardless of their insurance status or ability to pay, emergency physicians are an irreplaceable component of our nation’s health care safety net. At least 8% of all ED visits are provided to uninsured patients. The frequent delivery of these non-reimbursed services makes the reimbursement rates of other payers, including Medicare, even more critical. This is compounded by the increasing acuity of patients seen in the emergency department. The ability of emergency medicine practices to stay afloat has been shaken by the volatility of the COVID-19 pandemic and insurers seeking to reduce payments for medically necessary services.  This has already forced practices to close, reducing access to care in some communities and leading to unnecessary consolidation.   We call on Congress and other policymakers to ensure that Medicare fairly reimburses emergency services and avoids these across-the-board cuts that threaten the ability of emergency medicine practices to remain solvent and continue to provide care to our country’s most vulnerable patients. edpma.org/