The U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans.
“No patient should forgo care for fear of surprise billing,” said HHS Secretary Becerra. “Health insurance should offer patients peace of mind that they won’t be saddled with unexpected costs.”
Among other provisions, today’s interim final rule:
Bans surprise billing for emergency services. Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization.
Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates.
Bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.
Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.
These provisions will provide patients with financial peace of mind while seeking emergency care as well as safeguard them from unknowingly accepting out-of-network care and subsequently incurring surprise billing expenses.
Tackling surprise billing is critically important, as it often has devastating financial consequences for individuals and their families. Two-thirds of all bankruptcies filed in the United States are tied to medical expenses. Researchers estimate that 1 of every 6 emergency room visits and inpatient hospital stays involve care from at least one out-of-network provider, resulting in surprise medical bills. And a 2019 study by the Government Accountability Office (GAO) – PDF, found that the median price charged by air ambulance providers ranged from $36,400 to more than $40,000, and over 70% of these transports were furnished out-of-network, meaning most or all costs fell to the insured individual alone. HHS, Labor, Treasury, and OPM are promulgating rules that will protect consumers from financial ruin simply because they could not ask for an in-network provider during their treatment.
“No one should ever be threatened with financial ruin simply for seeking needed medical care,” said U.S. Secretary of Labor Marty Walsh. “Today’s Interim Final Rule is a major step in implementing the bipartisan No Surprises Act that will protect Americans from exorbitant health costs for unknowingly receiving care from out-of-network providers.”
“Facing a difficult medical situation is challenging enough – no one should then face a surprise medical bill when they get home,” said OPM Director Kiran Ahuja. “This interim rule helps to protect Americans from financial ruin and honors federal employees, retirees, their covered family members and other enrollees who receive healthcare through the FEHB Program, the largest employer-sponsored plan, by giving them new protections from unexpected medical bills.”
Today’s interim final rule with request for comments implements the first of several requirements passed with bipartisan support in title I (the “No Surprises Act”) of division BB of the Consolidated Appropriations Act, 2021. The regulations issued today will take effect for health care providers and facilities Jan. 1, 2022. For group health plans, health insurance issuers, and Federal Employees Health Benefits Program carriers, the provisions will take effect for plan, policy, or contract years beginning on or after Jan. 1, 2022.
Fact sheets on this interim final rule can be found here and here.
The interim final rule with comment period can be accessed here – PDF.
AHIMA released a new toolkit that aims to provide guidance to healthcare organizations about telehealth, as its use soared during the pandemic and many organizations are seeking to implement or expand their telehealth programs.
“Countries around the world are interested in increasing their use of telehealth, and for good reason,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “Telehealth can increase the quality and efficiency of care, while reaching underserved populations. We believe our new telehealth toolkit is an excellent resource for any healthcare professional looking for the steps required to successfully implement and maintain a telehealth program.”
While the pandemic accelerated the use of telehealth, the potential of digital health technologies to make health systems and services more effective was widely recognized before COVID-19, according to the toolkit. The toolkit’s authors highlight the benefits of a telehealth program, including enhanced access to care and timeliness. They also offer guidance to patients for telehealth appointments, recommending they:
Test the connectivity, battery, and operation of the camera, microphone, and speakers of the device to be used.
Use a private and quiet space where others cannot hear the sound of the video consultation.
Depending on the reason for the visit, they should consider wearing clothing that allows the doctor to examine them by video.
Consider making a written list of concerns and inquiries prior to the appointment.
The toolkit also contains an extensive overview of the definitions of telemedicine and telehealth, and features information for healthcare organizations considering a telehealth program, including:
Challenges and considerations for implementing a telehealth program, both technologically and organizationally.
A step-by-step guide on how to take a telehealth program from its initial stages to its implementation.
A comprehensive analysis of requirements to consider in advance of telemedicine implementation, from legal policies to documentation and reimbursement considerations.
The telehealth toolkit was developed thanks to the time and talents of 10 volunteers and is available for purchase at AHIMA.org.
By Ryan Hungate, DDS, MS, practicing orthodontist and founder and CEO, Simplifeye.
From Uber to Airbnb, disruption is all around us. While older generations may look at Millennials askance for changing the business and societal frameworks they built, it is undeniable that many changes make life easier. Many now prefer to do the bulk of their shopping through apps; tech-empowered logistics make one- and two-day shipping possible; requesting a taxi no longer requires a loud whistle; and scheduling appointments can now be done online.
Many platforms have emerged over recent years with frameworks empowering businesses to offer options for setting appointments and getting quick answers without relying on phone calls. The overarching feature is the ability to participate in live chat, 24 hours a day, seven days a week, to make inquiries and schedule appointments with real people, not chatbots. In addition to this, many of these platforms feature self-scheduling capabilities enabling people to book appointments via online portals, as well as streamlined invoicing capabilities so both businesses and customers can enjoy a seamless payment and record-keeping experience. Some providers have even integrated video portals to facilitate appointments, which offers convenience for both the business and patients.
To glimpse what this type of technology looks like in practice, imagine someone in need of an appointment with an optometrist to discuss a vision issue. The person may get busy at work, then go to the gym, and then head home. Later that night after dinner when the busy day finally winds down, the person at last remembers to set the appointment. Instead of having to wait until the following business day to make the call, the person visits the optometrist’s website and is immediately greeted with a friendly welcome message in a chat box staffed by a trained representative who can schedule the appointment within minutes.
Mental health awareness is reaching an all-time high. Conditions such as anxiety, depression, and substance addiction are finally starting to be taken seriously, and people are finally seeking necessary help. Almost 30% of Americans have seen a therapist during the pandemic, for example. Unfortunately, not everyone can afford a private therapist to help them.
As a result, there’s an increase in self-help apps that seemingly offer affordable mental health care. Although many of these apps are based on genuine psychological approaches and techniques, there’s one thing that most of them are lacking – cybersecurity.
Mental health apps aren’t obliged to follow many of the rules that the health sector typically complies with. For instance, they might not reassure that patients’ data will be safe and remain confidential from anyone.
Mental health apps as an alternative to therapy
Over the past few years, we’ve seen a significant rise in telemedicine (or remote healthcare). Patients can easily schedule virtual consultations with their healthcare providers. They can receive digital prescriptions or seek help over the phone. Most commonly, they can use online resources to deal with mental health issues.
Young adults are increasingly using social media as an alternative to therapy, whether by watching videos from therapists or using designated social media groups. Thus, health experts ask one important question: can people rely on an app to soothe their mental hurdles?
As these apps become smarter thanks to advances in AI and natural language processing, we can expect to see an increase in mental health app users. While they’re not always the best alternative to face-to-face therapy, they’re the most affordable option, making them an increasingly more popular choice.
Typical attempts at defining, quantifying, and measuring social determinants of health (SDoH) are limited to geographic or population averages, which often mask individuals’ discrete and unique experiences. They can, therefore, lead organizations to implement costly and inefficient programs instead of addressing individuals’ actual barriers that represent the greatest potential for improving health outcomes and return on investment.
Recognizing this, the Colorado Hospital Association (CHA) sought to gain a better understanding of the unique fingerprint of risk within its members’ patient populations—knowledge that would lead to more effective strategies for its members to address emergency department (ED) super-utilization and readmission rates with interventions that would produce the greatest return on investment.
The group partnered with Carrot Health to perform a statewide analysis on the relationship between ED utilization and readmissions and SDoH. Coupling claims data from CHA’s On Demand Hospital Information Network (ODHIN) and consumer behavior data from the Carrot MarketView platform enabled production of an industry-first analysis of healthcare utilization across Colorado.
SDoH and Readmission
The analysis provided deeper insights into the patterns and relationships observed through patient data, social risks, and ED utilization and readmissions. The latter – readmission – is a core utilization metric that has been identified by Colorado’s Medicaid payer as a key metric impacting hospital reimbursement under Colorado’s value-based Hospital Transformation Program (HTP). As a result, improvements in readmission and optimization of quality programs around it are paramount to CHA’s member hospitals.
Readmission is also an area where SDoH can have a significant impact, particularly within the Medicaid population where social determinants are often exacerbated. For this reason, the CHA determined that identification tools would play an important role in helping to quantify risk and identify opportunities for strategic program design, community outreach, and interventions by allowing for the visualization and highlighting of the relationship between readmissions and SDoH.
This would, in turn, allow CHA to determine the appropriate guidance for member hospitals seeking improvement in their quality efforts. To that end, CHA and Carrot Health constructed an interactive dashboard to help hospitals understand their specific patient population by identifying those who had been readmitted within 30 days and which SDoH were contributing to overall risk for readmitted patients.
The dashboard allows CHA to identify areas of increased social risk for by comparing patients who were readmitted against those who were not. It also allows member hospitals and health systems to examine patient populations by ZIP Code, payer, race/ethnicity and SDoH risk groups and draw insights within each population.
By Ajay K. Gupta, CISSP, MBA, CEO, HSR.health; Christine Nzokou, public health analyst.
Through its Sustainable Development Goals, the United Nations has identified maternal and child health (MCH) as the number one indicator of the health of a nation. MCH represents such health conditions as maternal mortality and morbidity as well as infant mortality and low birth weight during labor, delivery, and the post-partum period. While MCH is often thought of as an issue in the developing world, the United States suffers from the highest maternal mortality rates amongst developed nations.
Its rate of 20.1 maternal deaths for 100,000 live births stands in stark contrast to France’s 8 and Italy’s 2. According to the World Health Organization (WHO), maternal mortality is a health indicator that can show wide gaps in social conditions. It demonstrates the difference between the poor and the rich, however, such distinctions in health outcomes are too common. What may be less apparent is that MCH issues also reflect differences between racial backgrounds despite an individual’s income.
According to the Center for Disease Control and Prevention (CDC), The maternal mortality rate for Black women is over three times that observed for White women at 38.9 vs. 12.0 deaths for 100,000 live births. This disparity only increases with age. Most pregnancy-related deaths are preventable, however racial disparities in pregnancy outcomes have persisted overtime.
The state of Maryland serves as a microcosm of the disparities in maternal health outcomes across the US. Overall, the state has a rate of 19.7 deaths per 100,000 live births, ranking in the middle of US states overall but has been rising in recent years. (Louisiana is at the unfortunate end of the spectrum with a rate of 58.1 and California enjoys the top spot with the rate of 4).
Just as there is a disparity across the country, maternal mortality is not evenly distributed across Maryland with nearly 60% of such deaths occurring in three of the state’s 26 counties – Baltimore County, Baltimore City, and Prince George’s County. These counties noticeably have the highest African American populations in the state as well further highlighting the disparity.
Given that the rates of maternal mortality are unevenly distributed, a broad-based interventional strategy may be ineffective as it may not reach those at high risk. A targeted approach may be more effective. Therefore, what is needed is a mechanism to identify who may be at high risk of maternal mortality, and where interventions are most likely to be most impactful.
Geospatial analysis allows for this. This mechanism uses health indicators to identify differences among local populations that are likely to cause poor outcomes. A geospatial analysis can track down to the community level maternal health risk factors, such as obesity and diabetes, in addition to trends in population growth and demographic changes, along with social determinants of health. Through these measures, a comprehensive risk stratification can be established to help community health and wellness organizations, women’s health providers, and health systems have the visibility they need to truly make a difference.
This one additional critical step can enable the care interventions that reduce the instances of maternal mortality.
Managing your healthcare personnel’s shifts is no easy feat. It can be a colossal nightmare, particularly if you’re handling hundreds of staff across multiple healthcare facilities.
If you don’t manage personnel shifts properly, chaos can ensue and negatively impact your staff’s morale, service delivery, and your entire operations.
That’s what we’ll help you find out in this guide.
1. Simplify your staff scheduling
A key aspect of managing your healthcare personnel shift scheduling is to keep it as simple as possible.
The more complex your staff scheduling process is, the more time-consuming, inefficient, and likely it is to be filled with errors. This can easily lead to scheduling issues and inefficient workflows that prevent you from delivering quality services.
One such solution is Deputy. The software’s simple scheduling app lets you create your staff schedule with a few clicks. As a result, you can do away with using an often chaotic and confusing spreadsheet or other tool that requires manual scheduling.
This saves you and your managers boatloads of time while ensuring you maintain ideal staffing in all your facilities. On the Deputy scheduling interface, click a specific date to add a shift. Then, configure the details by assigning staff, choosing a department, adding break times, and other information.
Once you’re done, save the schedule and create other personnel shifts accordingly. If a staff calls in sick, fill in the shift with a qualified replacement efficiently by letting employees use the app to swap schedules with your other eligible personnel.
Telemedicine and essay writing share one unexpected similarity. Essay helpers from EssayHub and other services had also been largely stereotyped before their contribution to the education field was recognized. Nowadays such services are widely used by most students with no twinge of guilt.
A decade ago, if you told anyone that you were using telemedicine, they would think you had lost your mind. Today, in the era of the global shortage of healthcare practitioners, telemedicine actually gives hope for better access to qualified medical help.
In fact, telemedicine is even better than traditional healthcare when it comes to its application.
Telemedicine Is More Convenient and Accessible
Before COVID-19 stroke, telemedicine helped citizens of rural areas get quality medical help on time. It aided millions of people with chronic diseases to maintain their living standards, control their treatment, or stay healthy.
During the lockdown, telemedicine has become the only possible way to connect with a health practitioner and get professional advice on one’s medical condition. Hospitals were crowded with coronavirus patients, and many people were banned from leaving their homes.
of all bankruptcies filed in the United States are tied to medical expenses. Researchers estimate that 1 of every 6 emergency room visits and inpatient hospital stays involve care from at least one out-of-network provider, resulting in surprise medical bills. And a 2019 study by the Government Accountability Office (GAO) – PDF, found that the median price charged by air ambulance providers ranged from $36,400 to more than $40,000, and over 70% of these transports were furnished out-of-network, meaning most or all costs fell to the insured individual alone. HHS, Labor, Treasury, and OPM are promulgating rules that will protect consumers from financial ruin simply because they could not ask for an in-network provider during their treatment.
By Kurt Waltenbaugh, CEO, 
