ABL HEALTHCARE ONLINE
ABL Healthcare Member News & Industry Trendletter * January 7, 2021
WELCOME NEW MEMBERS!

>>> Gabe Stein is Executive VP of GeBBS Healthcare Solutions, and also leads the Payer Solutions Division's sales, operations, marketing, and strategic vision, focusing on driving growth in revenues and profitability. GeBBS is a KLAS-rated leading provider of Revenue Cycle Management services and risk adjustment solutions firm that boasts innovative technology, combined with a global workforce (8,300 in India, 700 in the Philippines, and 150 in the U.S.). Prior to joining GeBBS in 2017, Gabe served as CEO and then Managing Director of Peak Health Solutions, responsible for growing the company's product development, business development, and marketing enterprises. Gabe was also previously President of AlzBetter LLC, in New Jersey, whose patent-pending program for Alzheimer's and dementia patients is a comprehensive blend of technology, care coordination, training and support developed from years of experience and scientific research. Earlier, he was a National Sales Manager with Maxim Healthcare, and served in the U.S. Army and Coast Guard. Gabe has joined the ABL-Health LA Round Table.

>>> Bernadette Vincent is COO of Satellite Healthcare, since March 2020, and was most recently Chief Field Operations Officer, since mid-2018. Satellite is a leading nonprofit dialysis provider, and Bernadette oversees operations in all service lines and several administrative functions, like managed care, procurement, Incident Command System for COVID-19 pandemic and crisis, bio-medical services, leadership development, and staff training and education. She is also GM of Satellite's Ambulatory Surgery Center, Tri-County Vascular Center. Prior to joining Satellite, Bernadette was with Mednax Services, in Florida, as COO Ambulatory Services and COO West Division. Before that, she was with Fresenius Medical Care, as Group VP South Division and VP of Operations. Earlier, she was VP of Medical Management at Peoples Health; Regional VP at Fresenius; and Senior Director Medical Management at Kaiser Permanente of Ohio. A registered nurse and former dialysis nurse with many years of clinical experience, Bernadette has joined the ABL-Health OAK Round Table.

UPCOMING ABL-HEALTH
ROUND TABLES
    To ensure the safety of our Members, these upcoming invitation-only events will be held via ZOOM. See your Round Table invitation for participation instructions, and the ABL.org Members Only website for all the Healthcare Round Table invitation specifics. (If you haven't already received an invitation to a ZOOM Table you would like to attend, please email mimi@abl.org for details.)

  • 1/06 - ABL-Health OC Zoom Table
  • 1/12 - ABL-Health SV Zoom Table
  • 1/13 - ABL-Health SF Zoom Table
  • 1/15 - ABL-Health LA Zoom Table
  • 1/21 - ABL-Health OAK Zoom Table
  • Explore Membership in ABL's Executive Round Tables >>>
Click on Headlines to Read Articles
ABL-HEALTH MEMBER NEWS

TELEHEALTH: COVID's
Healthcare Superstar

                     Blog by Mimi Grant

If there's a silver-lining that's emerged from the past nine months of our collective misery, it's been the rapid embrace of telehealth by physicians, therapists, pharmacists, and patients alike. And, based on the feedback from the provider Members in Wednesday morning's ABL Healthcare ZOOM Table, it's never going back to its limited pre-COVID norm. In fact, according to a Medical Economics industry survey, "83% of patients expect to use telemedicine after the pandemic resolves."

A prime example of how far we've come with Telehealth was revealed in my recent exchange with Artie Southam, MD, EVP of Health Plan Operations and Chief Growth Officer at Kaiser Permanente, who is also the co-national executive sponsor of Kaiser's Telehealth activities. Although, as Artie said, "we were fortunate to have a head start going into COVID" - pre-pandemic, they were already conducting 15% of scheduled outpatient visits virtually. "And we are fortunate that our economic model [flat, monthly payments] supports sustained investment in these types of services."

Nonetheless, when COVID struck, the organization shifted dramatically to telehealth; as Artie confirmed, they ended 2020 having provided 30.5 million (synchronous, voice or video) telehealth visits to their members, equaling 49% of all their outpatient encounters for the year - including an 80% highpoint in the early spring. These televisits are above and beyond the 400 million visits to kp.org, where "about 40 million [asynchronous] secure visits took place, and members exchanged secure 'emails' (including attachments) with their KP providers." And, while Kaiser's telehealth percentage is currently ~50% of all outpatient visits, Artie is focused on always improving "the telehealth experience - the waiting room, and the start, and the finish - [so it's] a really good consumer and clinician experience."

Other providers and systems that didn't have Kaiser Permanente's head-start - or prepaid "economic model" - were thrown into catch-up mode using whatever technology was at hand...

CLICK HERE TO READ THE REST OF MIMI'S POST & LEAVE COMMENTS ON LINKEDIN

 
EXPANDED ARTICLES
ABL-HEALTH MEMBER NEWS
Alvaka Networks Shares the Amount of a Typical Ransomware Demand

In How Much is a Typical Ransomware Ransom?, Alvaka Networks reports that by May 2020 ransoms had tripled to $200-300k, and by September 2020, they were seeing $1-2M-plus ransoms. Last month, Alvaka's Oli Thordarson saw his first $20M ransom. And, because of these large, and growing, ransom demands, as well as additional factors, Alvaka has published: Top 5 Reasons to Invest in Cyber Breach Insurance. Meanwhile, Oli shares an article - Ransomware will likely get worse in 2021: report - which says that, in 2021, hospitals are likely to remain major targets, amid the pandemic, as criminals "casually blow past any ethical red lines." It also says the average ransom payment jumped 31% to $233,817, in the third quarter from the second quarter. (Oli Thordarson, OC)

Axene Health Partners Suggests the Good That Will Come Out of COVID-19

In What Good Will Come Out Of COVID-19?, Axene Health Partners discusses "some of the good things that will help shape our future," including medical testing; virtual medicine; vaccine development; sanitation and cleanliness; social health awareness; and delivery services. And, in The ACA's Silver Bulletin, Axene asks, "What if I told you that two sentences in a rate filing guidance could potentially add $5 billion of federal subsidies to the individual market and bring substantial premium relief to low-income consumers across the nation if implemented by every state? And that doing so would not be a "gimmick" designed to increase federal spending but rather correcting anti-consumer pricing distortions by properly enforcing current ACA rating rules and assuming rational consumer behavior?" (John Price, SF)

Choice in Aging CEO Spotlighted in News Video on COVID-19 Vaccine

Debbie Toth of Choice in Aging is featured in this recent ABC7 News video: Seniors near front of the line for COVID-19 vaccine, but will they take it? Meanwhile, recent episodes of the "Dishing with Debbie" video series include interviews with: Assemblymember Adrin Nazarian; California State Treasurer Fiona Ma; and Contra Costa County Supervisor Diane Burgis. (Debbie Toth, OAK)

Covisus Wins 2020 AIDC Award for Its Revolutionary Tech

AIM recently named Covisus the 2020 Automatic Identification and Data Capture Award Winner for its breakthrough vTag technology, a tagless track-and-trace solution for item/package-level covert traceability, ideally suited to meet regulatory requirements and to help prevent counterfeit activities. Covisus' vTag is currently being adopted by the medical device and military/aerospace communities. AIM is a leading industry association in innovation, standards, and solutions in barcode, biometrics, IoT, NFC, RFID, RTLS, and RAIN. (Naresh Menon, Ph.D., LA)

El Camino Health & Bloom Energy Deploy Shield T3 to Curb COVID

Bloom Energy and El Camino Health (ECH) announced the launch of the University of Illinois' innovative Shield T3 COVID testing system and mobile laboratory at Bloom Energy's manufacturing facility in Sunnyvale, CA. The new mobile lab, overseen by ECH, is open to Bay Area businesses and schools for simple, rapid and inexpensive COVID-19 testing. Meanwhile, ECH's Mountain View Hospital earned an 'A' in the Leapfrog Hospital Safety Grade program, which uses up to 27 measures of publicly available hospital safety data to assign grades to 2,600+ U.S. acute-care hospitals twice per year. (Cecile Currier, SV)

GeBBS Ranked in Top 10 of Largest Revenue Cycle Management Companies

GeBBS Healthcare Solutions was named to Modern Healthcare's list of the nation's Top 10 largest revenue cycle management companies. The list includes 24 firms that have dedicated practice areas and staff to address the needs of the healthcare revenue cycle process. (Gabe Stein, LA)

Kaiser Permanente Tops National Survey on Customer Satisfaction

Kaiser Permanente (KP) rated highest in customer satisfaction in a recent national survey of 2,200+ healthcare policy holders conducted by Insure.com. The survey ranked the 15 leading health insurers on value for price, customer service, website and mobile app usefulness, and more. Also, 29 KP hospitals received "A" grades in the Leapfrog Group's latest Hospital Safety Grade report. (Marcos Vasconcelos, OAK)

Kencor Discusses Importance of User Interface & Experience Design in Healthcare

In Healthcare UI/UX Patient Engagement & Design in 2021, Kencor examines several things to watch for in the new year and beyond: artificial and virtual reality in healthcare; telehealth and telemedicine; healthcare bots; and devices and wearables. (Muthu Krishnan, SV)

King & Spalding Wins Accolades & Provides Healthcare Law Info

U.S. News & World Report and Best Lawyers ranked multiple King & Spalding practices across the U.S. in its 2021 "Best Law Firms" edition, including Tier 1 designations in 21 practice areas, including Health Care Law and FDA Law nationally, as well as 119 regional rankings, including Tier 1 in Los Angeles and Sacramento in Health Care Law.
Meanwhile, on January 12, Marcia Augsburger will co-present at a webinar - The New Frontier in Managed Care: An Overview of the Newly Passed Federal Surprise Billing Legislation - at 9:30 a.m. Pacific.
And, on January 7, 14 and 21, K&S will present a three-part webinar - Recalculating: Major Stark, Anti-Kickback and CMP Final Rule Changes Are Taking Us in a New Direction - at 10 a.m. Pacific.
Plus,
read Key Takeaways From the 13th Annual King & Spalding Medical Device Summit and Congress Restores Application of Federal Antitrust Laws to Health Insurers. (Marcia Augsburger, JD, SF & Travis Jackson, JD)

KMD Architects Gives Progress Report on Pacific NW National Laboratory

KMD Architects recently shared on LinkedIn that "amazing progress in pathogen discovery is happening at a facility we designed for the Pacific Northwest National Laboratory (PNNL) in Richland, WA. The PNNL Biological Sciences Facility and Computational Sciences Facility are connected by a two-story, transparent atrium that provides shared common spaces where researchers from both disciplines can collaborate and share ideas. (Rob Matthew, SF)

LigoLab Details "The Journey to One Million COVID-19 Tests"

In The Journey to One Million COVID-19 Tests, LigoLab provides an update on its partner Reditus Laboratories, which recently surpassed one million tests for SARS-CoV-2. "Quite a remarkable accomplishment, especially when you consider the practice had only just added molecular diagnostic testing to its growing histopathology business in April, just as the first wave of the pandemic was hitting central Illinois. So how did they do it, and how can other laboratories follow suit?" (Suren Avunjian, LA)

Mazzetti Encourages Healthcare Climate Leadership

In his recent article on LinkedIn, Walt Vernon of Mazzetti discusses the promise and challenges of achieving carbon neutrality, including for healthcare organizations. He also provides a link to Mazzetti's recent paper, 2030: Next Steps to Healthcare Climate Leadership, and links an excellent 4-minute video capsule of key quotes from several of the contributors to the booklet. Authorities included in the project are ABL Members Dave Sayen and Greg Buchert, MD. (Walt Vernon, JD, SF)

MedWand Wins "Best of What's New" from Popular Science

MedWand has been honored with a 2020 "Best of What's New" award in the Health category by Popular Science magazine, which noted that "telehealth has long had the potential to transform healthcare for people living in rural areas or those who can't physically get to the doc, but the COVID-19 pandemic has made it even more critical." Meanwhile, MedWand will be participating in the CES 2021 Virtual Conference, on January 12, in a presentation on Telehealth: Augmenting the Experience with Technology. (Bob Rose, OC)

Mission Hospice Presents Event to "Redefine Hope at the End of Life"

Upcoming events from Mission Hospice include Redefining Hope at the End of Life, on January 14, in which psychology professor Dr. David B. Feldman will discuss research and casework to explore how the meaning of hope shifts from cure to quality of life. He will suggest practical ways that professionals can help the people they serve make this important shift; and The Five Invitations, discussion #1: Don't Wait, on Jan. 20, which will be part one of a six-part facilitated exploration of what death can teach us about living fully. (Dolores Gomez, SF)

Nelson Hardiman Explains New California Employment Laws

Harry Nelson of Nelson Hardiman (NH) appeared on KTLA5 to discuss California's 2021 new laws, including those relating to healthcare and employment, such as the new COVID exposure notification requirements. And, Harry was interviewed by TechTarget regarding the absence of a federal COVID-19 liability shield for states.
Meanwhile, recent NH Client Alerts include: What to Do If the FBI Comes Knocking; Cal/OSHA Adopts Emergency Covid-19 Prevention Regulation; and Stark and Anti-Kickback Rules Finalized. (Harry Nelson, JD, LA)

OneLegacy Participates in TV Special & Featured in LA Times

OneLegacy and Donate Life participated in the January 1st Tournament of Roses 2021 TV special, exhibiting their 25-foot floral sculpture, entitled "Community of Life," which honored 21 organ and tissue donors as well as six donation healthcare heroes who have helped give others a second chance at life. Also, OneLegacy was recently highlighted in the Los Angeles Times Gift Giving Guide for its support of initiatives to improve organ, eye, and tissue donation and transplantation. (Tom Mone, LA)

PreludeDx Shares Insights on its Test from Cleveland Clinic Physician

In this four-minute video, "Dr. Chirag Shah, Cleveland Clinic, discusses clinical outcomes results presented at the recent San Antonio Breast Cancer Symposium and the impact on clinician decision making today regarding radiation therapy. Dr. Shah shares that the key results of the study showed that by using DCISionRT, from PreludeDx, physicians can potentially reduce overtreatment of radiation by reducing the number of DCIS patients recommended to receive radiation. And in a subset of patients, increased the recommendation for radiation therapy following the test, thus potentially enabling appropriate treatment decisions and avoiding over- or under-treatment." (Dan Forche, OC)

Satellite Healthcare's Rick Barnett to Retire

Long-time ABL Member Rick Barnett has announced his upcoming retirement as CEO of Satellite Healthcare, effective on January 31, 2021. In his six years leading Satellite, Rick directed successful campaigns to expand service to Hawaii and to key care providers, including national pharmacy chains and healthcare systems. He was integral in making improvements to Satellite's patient quality, service and physician relationships. Rick is looking forward to serving on boards of directors and advisors. Meanwhile, Satellite's Jim Glafkides remains an ABL-Health SV Round Table Member and COO Bernadette Vincent is joining the ABL-Health OAK Round Table. And, the Satellite Healthcare Board, chaired by ABL-Health OC Member Chris Selecky, has selected Jeffrey Goffman as Satellite's new CEO.

Savi Group Explains How Covid Vaccine Billing & Coding Will Work

In COVID-19 Vaccines Are Here: How Billing & Coding Will Work, Savi Group provides specific information on the medical billing process behind these developments. And, Easy Ways to Reduce Medical Billing and Coding Errors offers tips to help develop a smoother revenue system, reduce denial rates, and improve patient care. (Sumit Mahendru, OC)

VivaLNK Expands Medical Data Platform; Sees Rapid Growth in RPM

VivaLNK recently announced the expansion of its Medical Data Platform for global partners - designed for rapid development and deployment of remote patient monitoring applications, and ensuring patient vitals can be captured continuously from any location and delivered successfully to clinical applications. VivaLNK has expanded its partners in Europe with the addition of CardioCalm in Italy, Avittia in Greece, and Current Health in the UK. The company now boasts over 90 healthcare solution partners across 22 countries. (Jiang Li, Ph.D., SV)

Wipfli Earns Registered Provider Organization Authorization

Wipfli has been certified as a Registered Provider Organization (RPO), noting that in 2020 the Department of Defense enacted new rules to expand cybersecurity requirements within its supply chain. These new rules established the Cybersecurity Maturity Model Certification (CMMC), which businesses must achieve in order to be awarded new contracts by the DoD. RPOs [such as Wipfli] can advise DoD suppliers on how to prepare for their CMMC assessment and achieve the certification. (Jeff Johnson, OAK, & Steve Rousso)

HEALTHCARE INDUSTRY NEWS & TRENDS
COVID-19 TRENDS
ABL-Health OC Members Recommend DIY Treatments to Speed Recovery from COVID

During Wednesday's ABL Orange County Healthcare Round Table, several Members commented on the climbing numbers of patients testing positive for COVID - including at least two ABL Members. Among them was Jennifer Ty, CEO of Excell Home Care, DNP, APRN, NP-C, FNP-BC, PMHNP-BC, WCC, OMS, LNC (and a 2020 "Innovator in Healthcare" awardee). After leading Excell's COVID testing program for months, she quickly recognized the symptoms - fever, severe muscle aches, headache, congestion, loss of taste and smell - when she began to feel them herself. Rather than go to bed to recover, she got to work concocting - and taking - a "COVID Recovery Cocktail" of Medrol Dosepak*, Z-Pak*, Zinc (220 mg), Vitamin C (1000 mg), Vitamin D, Tumeric with Ginger, Pepcid (to counter hyperacidity related to the medications), steam inhalation of salt dissolved in hot water morning and night, and walking in the sun for up to 4 miles a day. Plus, she drank lots of water and hot tea. Within a week she started to feel better, and tested negative. Now, Excell is recommending this treatment regimen to their nurses and each patient they test, who tests positive. (*Medrol Dosepak and Z-Pak are prescription drugs)

Later, ABL OC Member Kim Darling, CEO of Competitive Health, sent the results of a study that concluded, "Sunlight exposure increased COVID-19 recovery rates: A study in the central pandemic area of Indonesia." And, George Carpenter referenced a report on a study published in Nature (and sponsored by Colgate), that concluded "mouthwash formulas with cetylpyridinium chloride (CPC) neutralise the virus that causes COVID-19 by 99.9%" after 30 seconds of gargling with Colgate's Plax, Total and Zero mouthwashes. [According to Amazon, mouthwashes by Crest, Listerine, CloSys, and Equate also contain CPC.]

Free PPE Offered to LA County Small Businesses

ABL Member Naresh Menon of ChromoLogic and Covisus passed along this information about PPE Unite, which is distributing a one-time 30-day supply of PPE at no cost - face masks, hand sanitizer, and/or face shields, to eligible small businesses in the County of Los Angeles. Naresh says "It's legit;" his company got a month's supply at no cost.

California Relaxes Nurse-to-Patient Ratio Law

California Governor Newsom has relaxed the state's nurse-to-patient ratio law, which gives hospitals the option to increase the number of patients per nurse - 170 hospitals have done so. ICU nurses can now care for three patients instead of two; ER and telemetry nurses can care for six patients instead of four; and medical-surgical nurses can care for seven patients instead of five. Some nurses are worried the current nurse-to-patient ratios will become permanent (https://www.beckershospitalreview.com/public-health/california-hospitals-grapple-with-covid-19-surge-6-things-to-know.html)

LA County Paramedics Told Not to Transport Some Patients with Low Chance of Survival

Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival as Los Angeles County grapples with a new wave of COVID-19 patients that is expected to get worse in the coming days. The LAC Emergency Medical Services Agency issued a directive Monday that ambulance crews should administer supplemental oxygen only to patients whose oxygen saturation levels fall below 90%. In a separate memo from the county's EMS Agency, paramedic crews have been told not to transfer patients who experience cardiac arrest unless spontaneous circulation can be restored on the scene. (https://www.npr.org/sections/coronavirus-live-updates/2021/01/05/953444637/l-a-paramedics-told-not-to-transport-some-patients-with-low-chance-of-survival)

OC Continues to Break Coronavirus Records with 501 ICU Patients in Local Hospitals

As of January 4, the Orange County Business Journal reported that the number of COVID-19 patients requiring ICU hospitalization jumped 34% in the past two weeks, according to data from the Orange County Health Care Agency. There were 2,097 total hospitalized patients, up 25% from the 1,682 hospitalized two weeks ago. The County continues to have 0% ICU capacity on an adjusted basis, which takes into account the ratio of COVID to non-COVID patients, and 7.5% on an unadjusted basis. (https://www.ocbj.com/news/2021/jan/04/covid-19-oc-business-updates/)

Skip Line for COVID-19 Vaccine & Lose Your License, Gov. Newsom Warns Providers

California Gov. Gavin Newsom announced that healthcare providers who violate vaccine priority guidelines will be penalized, including the revocation of their professional license. New York has also developed sanctions for deceptive vaccine distribution or administration: healthcare providers who commit COVID-19 vaccine fraud face a fine of up to $1 million and revocation of state licenses. (https://www.beckershospitalreview.com/legal-regulatory-issues/skip-line-for-covid-19-vaccine-and-lose-your-license-california-governor-warns-healthcare-providers.html)

Record Number of US Workers Are Calling In Sick

The number of people currently in the labor force who are out sick, known as absenteeism, has doubled in the pandemic, and may stay that way until COVID-19 vaccines are widely distributed, according to Bloomberg. Almost 1.8 million workers were absent in November because of illness, nearly level with the record of 2 million from April, according to Labor Department data. The latest Household Pulse Survey, a separate survey conducted by the Census Bureau, estimates that more than 11 million people weren't working because of COVID-19. Employee absenteeism is slowing the economic recovery in the U.S. and leading to supply chain disruptions. Manufacturing is especially affected by temporarily absent workers. (https://www.beckershospitalreview.com/workforce/record-number-of-us-workers-are-calling-in-sick.html)

HEALTHCARE & GOVERNMENT
Court of Appeals Upholds CMS Rule Requiring Public Disclosure of Prices Negotiated Between Hospitals & Insurance Companies

On December 29, 2020, the U.S. Court of Appeals for the District of Columbia Circuit upheld a CMS final rule promulgated in November 2019 that requires hospitals to disclose various forms of pricing information related to the items and services they provide. In particular, the rule requires hospitals to disclose charge rates including gross charges from chargemasters; payer-specific negotiated charges; standardized discounted cash prices offered to self-pay patients before any individualized discounts; and the maximum and minimum third-party negotiated charges for a given item or service. The American Hospital Association, joined by other associations and individual hospitals, challenged the rule but the district court awarded summary judgment to the government. AHA appealed, and the D.C. Court of Appeals has now upheld the rule that went into effect January 1, 2021. (https://kslawemail.com/128/7467/pages/article-1.asp?sid=7b765c1d-2f5b-4a01-aa31-558308c5fe2a)

HHS Increases & Begins Distributing $24+ Billion in Phase 3 COVID Provider Relief Funding

Edward G. Heidig, HHS Director of Region 9, recently wrote: "The Trump Administration, through the Health Resources and Services Administration is announcing it has completed review of Phase 3 applications from the Provider Relief Fund program and will distribute $24.5 billion to 70,000+ providers. Up from the $20 billion originally planned, the addition of another $4.5B in funding is being used to satisfy close to 90% of each applicant's reported lost revenues and net change in expenses caused by the coronavirus pandemic in the first half of 2020." Read More at https://www.hhs.gov/about/news/2020/12/16/hhs-increases-begins-distributing-over-24-billion-in-phase-3-covid-19-provider-relief-funding.html

CMS Issues Final Rule to Empower States, Manufacturers & Private Payers to Create New Payment Methods for Innovative New Therapies Based on Patient Outcomes

CMS finalized regulatory changes to modernize Medicaid prescription drug purchasing and propel payment innovation by providing states, private payers, and manufacturers more flexibility to enter into value-based purchasing arrangements for prescription drugs. With the new flexibilities under this final rule, manufacturers will be more willing to negotiate with payers, including Medicaid, with drug pricing being driven by the value of their drug to the individual patient. This is significant, especially in the era of new genetic-based treatments which may initially be expensive, yet in the long run offer significant value to the patient and payer. Payers will be able to negotiate prices with manufacturers for these genetic-based treatments based upon outcomes and evidence-based measures such as reduced hospitalizations, lab visits, and physician office visits, ensuring that if such measures fail to support the value of a drug, the payer is not held accountable for the full price. (https://www.cms.gov/newsroom/press-releases/cms-issues-final-rule-empower-states-manufacturers-and-private-payers-create-new-payment-methods)

"Surprise" Medical Billing Legislation Could Lead to "Surprise" Complications

A recent Wall Street Journal opinion piece said that it "will take months to digest everything in the Covid relief bill rammed through Congress and signed by President Trump [on Dec. 27]. Both parties are hailing an end to "surprise" medical billing, though ... you can expect this political response to surprise billing to cause more surprise complications." Also, "a 2019 analysis in JAMA Internal Medicine found that 39% of more than 13 million visits to an in-network emergency room between 2010 and 2016 ended in an out-of-network bill, frequently for services like radiology." (https://www.wsj.com/articles/surprise-a-health-lobby-cage-match-11609371346?mod=opinion_lead_pos4)

HHS Advisory Opinion Rejects Drug Manufacturers' Attempts to Limit Contract Pharmacy Use by 340B Covered Entities

On December 30, the HHS Office of General Counsel issued an Advisory Opinion finding the 340B Federal Drug Pricing Program requires drug manufacturers to extend 340B pricing to covered outpatient drugs dispensed through contract pharmacies. Recently, certain drug manufacturers have declined to distribute covered outpatient drugs through contract pharmacies at 340B pricing. The OGC concluded that this practice is impermissible and that drug manufacturers must offer covered drugs at no more than the 340B ceiling price, even if covered entities use contract pharmacies for distribution. (https://kslawemail.com/128/7467/pages/article-3.asp?sid=7b765c1d-2f5b-4a01-aa31-558308c5fe2a)

OTHER HEALTHCARE TRENDS
2020: Bad Year for Healthcare Cybersecurity

Through November - the most recent data available at deadline - 2020 set a record for data breaches. There were 576 incidents reported to HHS. As with everything else during the pandemic, even breaches continued their shift to digital, with network services being targeted 40% of the time. (https://www.modernhealthcare.com/technology/data-points-bad-year-cybersecurity-too) Meanwhile, the Wall Street Journal recently published an opinion piece - The Cyber Threat Is Real and Growing.

Haven, the Amazon-Berkshire-JPMorgan Venture to Disrupt Healthcare, is Disbanding After 3 Years

Haven, the joint venture formed by three of America's most powerful companies to lower costs and improve outcomes in healthcare, is disbanding after three years, CNBC reported. The move to shutter Haven may be a sign of how difficult it is to radically improve American health care, a complicated and entrenched system of doctors, insurers, drugmakers and middlemen that cost the country, according to CMS, a projected $4.01 Trillion in 2020. (https://www.cnbc.com/2021/01/04/haven-the-amazon-berkshire-jpmorgan-venture-to-disrupt-healthcare-is-disbanding-after-3-years.html)

Health Insurer Oscar Adds Another $140 Million in What's Likely a Pre-IPO Round

Oscar recently raised another $140 million in financing, meaning that the New York-based health insurance upstart raised the equivalent of $1 million a day for all of 2020. It's likely going to be one of the last times the company taps private markets before an eventual public offering. (https://techcrunch.com/2020/12/17/health-insurer-oscar-adds-another-140-million-in-whats-likely-a-pre-ipo-round/)

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