By George W. Chapman
Yes, they can. This will become more prevalent as the pandemic continues to surge.
Understandably, physicians must protect both their stressed out and frustrated employees and vaccinated patients from unnecessary exposure to the virus. Non-vaccinated patients have the option of being seen via telemedicine.
Critics have falsely claimed this policy violates a physician’s Hippocratic Oath. The oath requires a physician to do no harm. Exposing staff and patients to the virus constitutes doing harm. Physicians reserve the right to fire noncompliant patients. However, they must continue to care for patients in the middle of treatment or find them an alternative provider.
Providers may soon require new patients to furnish proof of vaccination. This would have to be approved by the insurance companies with which they participate.
2022 Insurance Rates
The pandemic has been a giant curveball and it has actuaries scratching their heads when pondering insurance rates for next year. They must tease out “normal” trends in healthcare utilization from “temporary” trends created by and endemic to the pandemic. The current surge of the delta variance does not make their calculations any easier. Keep in mind the ACA requires insurers to spend at least 85% of premiums and revenues on claims. They can retain 15% of premiums for profit and operating expenses. Any amount less than 85% must be rebated to employers or individuals. Insurers have three years to calculate and comply. Most insurers issued rebates in 2018 and 2019. So any fears of significant premium increases or price gouging by insurers in 2022 is mitigated by the ACA 85% rule. Actuaries did not factor in COVID-19 adjustments to their 2021 calculations due to the uncertainty created by the novel virus and that they had to issue rebates in 2018 and 2019. However, now that they have plenty of actual pandemic data, so there is less uncertainty. Most likely, COVID-19 adjustments will be factored into 2022 rates. Rates will vary by region based on the percentage of population vaccinated, COVID-19 related emergency room claims and of course hospitalizations. Theoretically, southeastern states could incur higher rate increases than northeastern states. MEDPAC, the Medicare advisory committee, is considering a temporary increase in payments to providers who are on the front lines of the pandemic war. Rural hospitals and physicians have been hit hardest by the pandemic.
Hospitals Under Siege
Hospitals and their staffs are our much-underappreciated frontline in the war against the virus. Currently, with the surge in the delta virus fueled primarily by vaccine hesitancy, it seems we are all losing the war. (1,500 deaths per day as of mid September.) Incredibly, despite massive staff burnout, turnover, resignations and financial distress, Congress is cutting their funding in the midst of the war. The shortsighted “Pay As You Go” act of 2010 decrees unbudgeted increases in overall federal spending triggers automatic cuts in some programs like — Medicare. In defense of the curious act, it was written almost a decade before the pandemic. Consequently, the hospital lobby has been busy. The mandated cut of 4% or $36 billion went into effect Sept. 30. Even if the lobby convinces Congress to cancel the 4% cut, their work is just beginning. Incredibly, the recently passed $1 trillion infrastructure bill calls for cuts to…Medicare to pay for it. And this was written in the middle of the pandemic. Cutting hospital funding in the middle of a war is patently absurd. On top of this all, the payroll tax supported Medicare hospital fund (Part A versus physician Part B) is projected to run out in five years. The main reason is less people working the past two years means less taxes collected once you go in to the the anatomy of a paystub.
Theranos Scandal
Three years since being indicted on 11 counts of fraud and conspiracy, the trial of Theranos founder Elizabeth Holmes has begun. “Wunderkind” Holmes quit Stanford after one year in 2003 to start a lab that promised to produce several blood assays on just a few drops of blood (versus the traditional several vials of blood). Investors including Walgreens, Henry Kissinger, Betsy DeVos and Rupert Murdoch were quick to dump more than $600 million into the fledgling startup Theranos. By 2015 the company was valued at an incredible $10 billion despite never having produced a single test. When asked to do so, she ran blood tests on standard blood analyzers. Holmes is facing 20 years in prison and $250,000 fine per 11 indictments.
Best Cities for Mental Health
A national survey conducted by a telehealth company ranked the quality of mental health services in our 50 most populous cities. Seven factors went into calculating the rankings: cost per therapy session; total prescription charges; mandatory treatment laws; criminalization of mental illness; provider to population ratio; poor mental health days; overall community well- being. The “best” cities were: Denver, Salt Lake, Minneapolis, Seattle, Hartford and Baltimore. The “worst” cities were: Dallas, Houston, San Antonio, Jacksonville, Orlando and Miami. As for entire states, Colorado had the lowest cost per therapy session at $115, one of the best ratios of providers per population at 1/70 and one of the lowest total prescription charges at just over $3 billion. (While that sounds high, we lead the world in prescription drug usage at $1,300 per person annually. The total mental health drug charges in “worst” city Dallas were more than $23 billion.) In Florida, with three of the “worst” cities, the average therapy session cost $142 an hour and there is only one provider per 590 people. The cities with the best provider to population ratios were New York, San Francisco and Portland.
Drug Prices
You have may noticed two new, ubiquitous, polar opposite, TV ads regarding drug pricing. One ad, sponsored by a consumer advocacy group, implores Congress and Medicare to use its vast purchasing power to fairly negotiate prices with drug manufacturers. Drug manufactures have been free to raise prices at will, totally unrestricted. (It should be noted that Medicare does not bother to negotiate prices with physicians and hospitals as it literally SETS what they will pay.) Medical debt, often the result of hugely expensive drug copays, is the number one cause of personal bankruptcy. The other ad is sponsored by the drug manufacturers. It attempts to scare people into believing their medicine will no longer be available if Medicare negotiates prices. There isn’t a drug company, let alone ANY company, in the world that would refuse to sit down and fairly negotiate with a buyer (Medicare) representing more than 160 million consumers. The drug ad leads you to believe innovation will be negatively impacted. Over the last five years, most of drug profits have gone towards buying back stock.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.