Feds Admit More Obamacare Co-Op Flops Ahead
Federal officials admitted for the first time Monday that the collapse of the largest and most costly of nearly two dozen Obamacare-funded health insurance co-ops may not be the program’s last failure.
The admission followed the collapse Friday of Health Republic of New York after regulators ordered the co-op “to cease writing new health insurance policies,” leaving 155,000 customers scrambling to find new coverage by the end of the year....
Doctors On Edge As Healthcare Gears Up For 70,000 Ways To Classify Ailments
Melinda Beck reports in the WSJ that doctors, hospitals and insurers are bracing for possible disruptions on October 1 when the U.S. health-care system switches to ICD-10, a massive new set of codes for describing illnesses and injuries that expands the way ailments are described from 14,000 to 70,000. Hospitals and physician practices have spent billions of dollars on training programs, boot camps, apps, flashcards and practice drills to prepare for the conversion, which has been postponed three times since the original date in 2011. With the move to ICD-10, the one code for suturing an artery will become 195 codes, designating every single artery, among other variables, according to OptumInsight, a unit of UnitedHealth Group Inc. A single code for a badly healed fracture could now translate to 2,595 different codes, the firm calculates. Each signals information including what bone was broken, as well as which side of the body it was on.
Propoenents says ICD-10 will help researchers better identify public-health problems, manage diseases and evaluate outcomes, and over time, will create a much more detailed body of data about patients' health—conveying a wealth of information in a single seven-digit code—and pave the way for changes in reimbursement as the nation moves toward value-based payment plans. "A clinician whose practice is filled with diabetic patients with multiple complications ought to get paid more for keeping them healthy than a clinician treating mostly cheerleaders," says Dr. Rogers. "ICD-10 will give us the precision to do that." As the changeover deadline approaches some fear a replay of the Affordable Care Act rollout debacle in 2013 that choked computer networks, delaying bills and claims for several months. Others recollect the end-of-century anxiety of Y2K, the Year 2000 computer bug that failed to materialize. "We're all hoping for the best and expecting the worst," says Sharon Ahearn. "I have built up what I call my war chest. That's to make sure we have enough working capital to see us through six to eight weeks of slow claims."
So the DEA has been seizing patient records without a warrant
...Drug Enforcement Administration agents have been accessing personal medical files without a warrant, generating a backlash from doctors and privacy advocates who say the practice is intrusive and unconstitutional — and have taken the agency to court.
“It’s just not right,” Texas attorney Terri Moore said.
The controversial record searches are part of the government’s effort to crack down on illegal “pill mills” and prescription drug abuse. But they’ve set up a clash over privacy rights, and a legal battle is now playing out in the 5th and 9th Circuit appeals courts. Lower courts have issued conflicting rulings to date, with one backing the DEA and another demanding the agency get warrants if it wants to look at patient records....