Unhappy UMMC pediatricians ‘loot’ to form own sub-specialty practice, lawsuits ensue

June 4, 2018, The Clarion-Ledger, Anna Wolfe- It’s a time of flux for the University of Mississippi Medical Center as it wages a public battle with the state’s largest insurance company; ushers in a new head of pediatrics; and constructs a $180 million tower for the children’s hospital. Under the surface, though, Batson Children’s Hospital has suffered a loss of sub-specialty pediatricians - 32 since 2016, during which the medical center has hired 25 - and not all of them are leaving the state to work for other hospitals. Several of the pediatricians have splintered off to work for a new local competitor of the university, prompting a nasty ongoing lawsuit that calls into question both the motives of departing doctors and the quality of the state’s only children’s hospital.

What’s in a medical bill? CL health reporter asks for your stories

June 4, 2018, The Clarion-Ledger, Anna Wolfe- Clarion Ledger Health Watchdog Reporter Anna Wolfe is examining medical bills from health care providers in our community. We’re looking at the circumstances that lead to sticker shock, potential solutions and what you, the patient, can do about it. Send us your medical bills, whether for an ER visit, an ambulance ride, a surgery, medication, or something as simple as a urinalysis at your local clinic. Maybe you went to an in-network hospital during an emergency but received charges from an out-of-network ER physician. Or an additional bill for the difference your insurance plan didn’t pay. Maybe you got a bill from a doctor you never saw or waited in the ER for services you never received but were still billed. Help us hold hospitals, doctors, insurance companies, state agencies and lawmakers accountable by sharing your story. So far, our reporting has led one hospital to change its scoring criteria for how ER visits are priced. Your input can help us achieve more impact.

The Health 202: Medicaid expansion in red states is likely to come via voters in November

June 4, 2018, The Washington Post, Paige Winfield Cunningham- When the Trump administration started this year allowing states to require work or volunteering by their Medicaid enrollees, there was lots of speculation that more GOP-led state legislatures would finally adopt Obamacare’s Medicaid expansion. But with the exception of Virginia, they mostly haven’t. Instead, the next states to expand Medicaid probably will do so if voters approve such a decision in November. Last week, Utah’s lieutenant governor announced there are a sufficient number of signatures for a ballot initiative to expand Medicaid, and activists in Idaho have said they’ve collected enough signatures for a ballot question, as well.“We have been polling for five years on how Utahns feel about medical expansion, and they’re on board,” RyLee Curtis, spokeswoman for the Utah Decides Healthcare campaign, told me. Utah and Idaho are among the 17 states holding out on Medicaid expansion under the Affordable Care Act.

In rural America, tightened access to Medicaid means tough choices

May 31, 2018, PBS, Laura Santhanam- In March, Casey Britton fed her two 13-page Medicaid renewal applications into an ancient fax machine in Linden, Tennessee’s career center before the state’s March 31 deadline. But on April 30, the state sent her a letter, saying it reviewed her paperwork and had decided she didn’t qualify anymore. Their coverage would end May 21, the letter read. On most days, even with Medicaid, Britton feels like she’s struggling to raise her two sons, ages 2 and 5, and get them the care they need. Without it, even the most basic medical care would become unaffordable. Thirty-two states and Washington, D.C., have expanded Medicaid access in recent years, and Virginia’s Senate this week voted to extend the health care program to 400,000 of its low-income residents. But in April, Tennessee legislators voted to set up work requirements for Medicaid recipients, joining a number of states, including Kentucky, Indiana, and Arkansas, that have passed similar laws in recent months.

Trump’s new insurance rules are panned by nearly every healthcare group that submitted formal commen

May 30, 2018, Los Angeles Times, Noam N. Levey- More than 95% of healthcare groups that have commented on President Trump’s effort to weaken Obama-era health insurance rules criticized or outright opposed the proposals, according to a Times review of thousands of official comment letters filed with federal agencies. The extraordinary one-sided outpouring came from more than 300 patient and consumer advocates, physician and nurse organizations and trade groups representing hospitals, clinics and health insurers across the country, the review found. Kris Haltmeyer, vice president of health policy and analysis at the Blue Cross Blue Shield Assn., said he couldn’t recall a similar show of opposition in his more than 22 years at the trade group, which represents Blue Cross and Blue Shield health plans and is among the organizations that have expressed serious reservations about the administration’s proposed regulations.

Why your health insurer doesn’t care about your big bills

May 30, 2018, CNBC, Marshall Allen- Michael Frank ran his finger down his medical bill, studying the charges and pausing in disbelief. The numbers didn’t make sense. His recovery from a partial hip replacement had been difficult. He’d iced and elevated his leg for weeks. He’d pushed his 49-year-old body, limping and wincing, through more than a dozen physical therapy sessions. The last thing he needed was a botched bill. His December 2015 surgery to replace the ball in his left hip joint at NYU Langone Medical Center in New York City had been routine. One night in the hospital and no complications. He was even supposed to get a deal on the cost. His insurance company, Aetna, had negotiated an in-network “member rate” for him. That’s the discounted price insured patients get in return for paying their premiums every month. But Frank was startled to see that Aetna had agreed to pay NYU Langone $70,000. That’s more than three times the Medicare rate for the surgery and more than double the estimate of what other insurance companies would pay for such a procedure, according to a nonprofit that tracks prices.