January 2022 Recap
Staying up to date on the latest healthcare news can be daunting. We at Medical Revenue Cycle Specialists hope to alleviate this pain for you in our weekly blog. We will touch on a few of the most pressing issues and trends that we are seeing in the healthcare space to keep you up-to-date with what's going on.
1. COVID
As we go on month 26 of the COVID-19 pandemic, healthcare organizations are still adjusting to the constant changes. COVID-19 has killed more than 870,000 people in the US alone and is not slowing down. On January 16, Xavier Becerra, Secretary of Health and Human Services, declared that a public health emergency exists and has existed since January 27, 2020. The trends in the US follow South Africa and the UK in that the omicron variant poses a greater risk for the young than past variants. Since the onset of the pandemic, over 10.6 million children have tested positive for COVID-19. The omicron variant accounted for 99.5% of new COVID infections in the US, with over 2 million cases in the final two weeks of January. Dr. Anthony Fauci claimed that most states would see a peak in omicron cases by mid-February. If the omicron surge ends soon, some health experts predict that the US will experience a lull period starting in March.
Last week the CDC shifted their message of being "fully vaccinated" to "up to date" with COVID-19 vaccines. This message comes after the recommendation for getting the booster shot. Three CDC studies were released on January 21 proving booster shots are needed in the fight against the omicron variant. The first study found that protection dropped from 94% during the delta wave to 82% for the omicron wave after the booster shot. During a White House briefing, CDC Director Dr. Rochelle Walensky said, "If you are eligible for a booster and haven't gotten it, you are not updated and need to get your booster."
The Federal Government began offering 1 billion rapid COVID-19 tests through COVIDTests.gov. Americans can order tests for free and have them mailed to their homes. As of January 15, private insurers will cover the cost of eight at-home rapid COVID-19 tests. This can cause payers to rely heavily on billing codes for reimbursement, and such codes have not been created yet. However, Medicare does not provide coverage for self-administered at-home tests.
Several states are continuing to use ineffective COVID-19 strategies. States with scarce supplies of monoclonal antibody therapies continue to use treatments that federal health officials warn no longer work against the highly contagious version of the virus. Additionally, an analysis of 41 health care systems found that health inequities and disparities have extended to COVID-19 treatments. From November 2020 through August 2021, Hispanic patients received treatments 58% less often than non-Hispanic patients. Black (22%), Asian (48%), or other race (47%) patients less often than white patients.
The American Hospital Association (AHA) is asking Congress to add $25 billion in additional relief to address the financial strain from the COVID-19 pandemic. The AHA noted that the "relentless and crushing workload on our stressed, tired, and burned-out caregivers persists," leaving healthcare personnel with extreme financial and operational challenges. With all of these obstacles facing healthcare personnel, medical appointments have become more challenging to schedule. Thus, many have turned to DIY healthcare. Some health professionals see this as a positive as more patients are aware of their health. In contrast, others see this as a potential danger as DIY healthcare can lead to missing more significant problems.
The CMS extends the COVID-19 vaccine deadline for health workers in 24 states. Health workers must be up to date on their vaccinations by March 15. The health workers in the other 26 states will need to be vaccinated by February 28. Before COVID-19, our country's civility and decency were declining. The US has never been so divided; these tips will help keep us together in this harrowing time: Respect others' Points of view, choose your words carefully, show empathy, respect diversity, and be willing to compromise.
2. Telehealth
Telehealth was one of the most significant emerging trends in 2021 and looks to continue in 2022. The 2021 State of Digital Health Report showed that global digital health investment rose 79% to $57.2 billion in 2020. This included 154 MEGA deals ($100 million of funding). Additionally, there are now 84 unicorns in the market (private companies valued at over $1 billion), with 13 'born' in 2021. Many believe telehealth could be an equitable 'bridge' in a post-pandemic world. Telehealth enhances patient engagement, expands access to care to reach more patients, improves overall healthcare quality, etc. While these are substantial benefits to telehealth, there are several complexities and concerns with using new technology regarding fraud, waste, and abuse for payers. Artificial Intelligence (AI) and Machine Learning (ML) tools have been deployed to prevent these errors and improve payment integrity.
With telehealth becoming a driving force in the industry, so has responded to patients' emails. This has become a dreadful part of the day for many physicians and health care professionals. Maria Byron noticed this and is leading a novel experiment that allows clinicians to bill for responding to emails. While this can create a new telehealth revenue stream, it could also generate another bucket for coding and billing.
3. Policy Updates
The Centers for Medicaid and Medicare Services (CMS) has been hard at work implementing new policies to provide improved medical care for patients. CMS is focusing on improving price transparency and market competition between health plans and reducing out-of-pocket costs for prescription drugs. CMS has proposed a rule to address significant issues in Medicare Advantage and Part D Health plans. In addition to adjusting current health plans, CMS determines Medicare coverage policies for new treatments. Many factors influence their decision, such as safety, price, availability, etc.
A prime example of this is CMS's evaluation and consequent unveiling of the Medicare coverage policy for Aduhelm, an experimental FDA-approved treatment for Alzheimer's. Aduhelm's effectiveness and safety is a hotly debated topic amongst healthcare professionals; thus, CMS has decided that Medicare will only cover those participating in clinical trials for the drug. This is to avoid disseminating a potentially hazardous treatment on a massive scale.
Following much deliberation, the Supreme Court ruled against the OHSA ETS mandate. However, this does not invalidate similar state-level policies approved by OHSA. The Court's rulings are not generalized judgments on the propriety or legality of mandatory COVID-19 vaccination policies. They only address whether Congress gave OSHA and CMS the authority to adopt the rules in question. Therefore, leaving the door open to similar vaccine mandates being implemented by state and local governments. Despite the Supreme Court deciding against the OHSA mandate, the Court ruled in favor of the CMS vaccination mandate. The mandate applies to all organizations that are CMS certified. However, organizations such as physician practices are not subject to the mandate as CMS credentialing does not equate to certification.
Access to patient health information (PHI) has been one of the critical issues facing healthcare providers and patients for many years. HIPAA has been working on a Final Rule for changes to the HIPAA Privacy Rule to address these issues. HIPAA hopes to improve data flow and access by easing restrictions on disclosures of PHI that require authorizations from patients to strengthen their rights to access their PHI. Additionally, the HHS considers changes to HIPAA and 2 CFR Part 2 regulations, providing privacy protection to patients with substance use disorders (SUD). The proposed changes will prevent doctors from prescribing treatments such as opioids to recovering SUD patients.
4. IT Updates
The Emergency Care Research Institute (ERCI) lists their top Health Technology Hazard for 2022 as cybersecurity. With the SolarWinds, Colonial Pipeline, and estimated 1,289 other cyberattacks occurring in 2021, cybersecurity in 2022 is imperative. The HHS estimates that the average bill for rectifying a ransomware attack in the healthcare industry is $1.27 million. To help improve cybersecurity, on January 18, the Biden administration published the TEFCA interoperability framework. The Trusted Exchange Framework and the Common Agreement (TEFCA) creates baseline requirements for sharing secure information across entities.
Additionally, medical devices have become an integral part of healthcare. However, these devices are often highly vulnerable to cyber threats. The Healthcare Supply Chain Association (HSCA) has released guidelines to improve the cybersecurity of medical devices. HSCA recommends some tactics to participate in an Information Sharing and Analysis Organization (ISAO), adopting IT security risk assessment methodology, such as the NIST Cybersecurity Framework (CSF), training employees to avoid phishing tactics, and appointing an information technology and network security officer.
Furthermore, artificial intelligence (AI) has become a vital part of the procurement decision support system. AI elevates Healthcare organizations' operational functions and improves their patient care. For example, Nightingdale Open Science, a new open science project, wants to accelerate ethical AI in medicine by collecting and cleaning clinical datasets for researchers.
5. Practice Management
Over 4 million people quit their job last November, with a large portion from health and social assistance services. Staffing shortages due to the Great Resignation are one of the three key labor trends for hospitals and healthcare providers in 2022. The HHS reports that nearly 13% of US hospitals are experiencing critical staffing shortages. This has led several hospitals to work through travel nurse challenges and find ways to alter the job to attract early career nurses.
Staffing shortages have proven to cause burnout for nurses and physicians and may be detrimental for patients! Approximately 90% of polled healthcare workers feel that staff shortages compromise patients at their hospitals. As these poor working conditions take their toll on healthcare workers, some have decided enough is enough. Hundreds of healthcare workers at Doctors Hospital of Riverside in California have decided to go on strike due to understaffing. Workers at the hospital claim that before COVID-19, the hospital was grossly understaffed, and now it has become unmanageable.
While staffing shortages contribute to provider burnout, so does poor medication management. Stericycle, a medical waste management company, surveyed 500 healthcare professionals and found that 93% of providers believe medical waste is integral to maintaining a safe and effective workplace. Both providers and administrators indicated that improper waste management contributed to burnout already faced by the pandemic.
6. Surprise Billing
On Monday, January 24, the Texas Medical Association (TMA) filed a brief opposing the No Surprise Act ruling for out-of-network pricing. The Act is intended to protect patients from receiving surprise medical bills for seeing an out-of-network provider. Physicians ultimately agree with the ruling but disagree with the pricing structure, implying insurers have a strategic advantage in determining price. The Texas lawsuit is just one of four legal challenges to the ban on surprise billing. One of Healthcare Dive's top four trends for payers and providers for 2022 is complying with the surprise billing ban. The American Medical Association (AMA) has filed lawsuits claiming that Congress favors insurers in the dispute resolution process with this legislation.
The Office of Inspector General (OIG) announced that it would conduct a national audit to inspect hospitals' compliance with COVID-19 relief payments. The OIG will look at providers' bills for out-of-network patients admitted for COVID-19 and monitor compliance with the surprise billing rule.