Surprise medical bills are the target of a new law. Here’s how it works : Shots

October 15, 2021 Vera

The No Surprises Act is intended to stop surprise medical bills. It could also slow the growth of health insurance premiums.

J. Scott Applewhite/AP

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J. Scott Applewhite/AP

The No Surprises Act is intended to stop surprise medical bills. It could also slow the growth of health insurance premiums.

J. Scott Applewhite/AP

Patients are months away from not having to worry about most surprise medical bills — those extra costs that can amount to hundreds or thousands of dollars when people are unknowingly treated by an out-of-network doctor or hospital.

The No Surprises Act — which takes effect Jan. 1 — generally forbids insurers from dropping such bills on patients and, instead, requires health care providers and insurers to work out a deal between themselves.

Some observers have speculated that the law will have the unintended consequence of shifting costs and leading to higher insurance premiums.

Many policy experts told KHN that, in fact, the opposite may happen: It may slightly slow premium growth.

The reason, said Katie Keith, a research faculty member at the Center on Health Insurance Reforms at Georgetown University, is that a new rule released Sept. 30 by the Biden administration appears to “put a thumb on the scale” to discourage settlements at amounts higher than most insurers generally pay for in-network care.

That rule, which provides more details on the way such out of network disputes will be settled under the No Surprises Act, drew immediate opposition from hospital and physician groups. The American Medical Association called it “an undeserved gift to the insurance industry,” while the American College of Radiology said it “does not reflect real-world payment rates” and warned that relying on it so heavily “will cause large imaging cuts and reduce patient access to care.”

Such tough talk echoes comments made while Congress was hammering out the law.

Here’s how the law will work and how it might affect insurance premiums and the health care industry.

Sending unsettled bills to arbitration

The No Surprises Act takes aim at a common practice: large, unexpected “balance bills” being sent to insured patients for services such as emergency treatment at out-of-network hospitals or via air ambulance companies. Some patients get bills even after using in-network facilities because they receive care from a doctor there who has not signed on with an insurer’s network.

Patients were caught in the middle and liable for

These 3 Health Tech Startups Are Case Studies – Crunchbase News

October 14, 2021October 14, 2021 Vera

March 12, 2020, was always going to be memorable for Jason Feldman, because that was the day his men’s health-focused startup, Vault Health, was set for a major rebrand and national rollout. But now the day is etched in his mind because it set his company on an unexpected trajectory that led to growth beyond his expectations.

On that mid-March Thursday, Feldman stood on the stock market floor in New York and witnessed the chaos as the country’s Dow Jones Industrial Average and S&P 500 saw the greatest single-day percentage dip since 1987.

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The founder and CEO was there to pose for photos and provide an interview to announce Vault Health’s next moves, but instead found the market was reacting to the COVID-19 virus. The deadly coronavirus had been declared a pandemic by the World Health Organization the day before, and would be branded a national emergency in the United States by then-President Donald Trump less than 24 hours later.

“I was there watching these investors on the floor of the stock exchange freaking out because the market literally was crashing,” Feldman remembered in a recent interview with Crunchbase News. “So we go back to the office, and I thought ‘What are we going to do?’ Because we had literally just launched the brand nine months before and built all this technology and here we are. Now I’m afraid that peoples’ jobs are at risk, and I don’t know how we’re going to live.”

Vault not only lived, but grew significantly over the next year and a half.

The pandemic set in motion a new trajectory for many healthtech startups, particularly those nimble enough to respond to a world crisis that confused and broke traditional public health care systems. And while tech’s contribution during the pandemic was a mixed bag of good and bad, those that figured out how to quickly fill the needs of scared residents, governments and companies have been rewarded.

Investors in the space raced to put money into digital health startups last year. In all, the industry raised $16.6 billion in investments globally while the pandemic raged on, up from $12.5 billion the year before, according to Crunchbase data. So far in 2021, the industry has raised nearly $20 billion in funding, the data show.

Of those that successfully made a pandemic pivot, many lucked out having existing partnerships

A Wrenching Farewell: Bidding Adieu to My Primary Care Doctor After Nearly 30 Years

October 14, 2021 Vera

I hadn’t expected the tears.

My primary care doctor and I were saying goodbye after nearly 30 years together.

“You are a kind and a good person,” he told me after the physical exam, as we wished each other good luck and good health.

“I trust you completely — and always have,” I told him, my eyes overflowing.

“That means so much to me,” he responded, bowing his head.

Will I ever have another relationship like the one with this physician, who took time to ask me how I was doing each time he saw me? Who knew me from my first months as a young mother, when my thyroid went haywire, and who since oversaw all my medical concerns, both large and small?

It feels like an essential lifeline is being severed. I’ll miss him dearly.

This isn’t my story alone; many people in their 50s, 60s and 70s are similarly undergoing this kind of wrenching transition. A decade from now, at least 40% of the physician workforce will be 65 or older, according to data from the Association of American Medical Colleges. If significant numbers of doctors retire, as expected, physician shortages will swell. Earlier this year, the AAMC projected an unmet need for up to 55,200 primary care physicians and 86,700 specialists by 2033, amid the rapid growth of the elderly population.

Stress from the covid pandemic has made the outlook even worse, at least in the near term. When the Physicians Foundation, a nonprofit research organization, surveyed 2,504 doctors in May and June, 61% reported “often experiencing” burnout associated with financial and emotional strain. Two percent said they had retired because of the pandemic; another 2% had closed their practices.

Twenty-three percent of the doctors surveyed said they’d like to retire during the next year.

Baby boomers, like me, whose medical needs are intensifying even as their longtime doctors bow out of practice, are most likely to be affected.

“There’s a lot of benefit to having someone who’s known your medical history for a long time,” especially for older adults, said Dr. Janis Orlowski, AAMC’s chief health care officer. When relationships with physicians are disrupted, medical issues that need attention can be overlooked and people can become less engaged in their care, said Dr. Gary Price, president of the Physicians Foundation.

My doctor, who’s survived two bouts of cancer, didn’t mention the pandemic during our recent

Most adults shouldn’t take daily aspirin to prevent heart attack, panel says

October 14, 2021 Vera

Taking a daily low-dose aspirin has long been recommended for heart health, but an influential organization changed its guidance on Tuesday.

The U.S. Preventive Services Task Force, an independent panel of experts, released an updated draft recommendation that says most adults not take aspirin to prevent first heart attacks or strokes.

The previous guidance recommended daily low-dose aspirin for people over 50 who were at higher risk for heart attacks or strokes in the next decade and who weren’t at higher risk for bleeding.

The updated guidance recommends that adults in their 40s and 50s only take aspirin as a preventive measure if their doctors determine they are at higher risk for heart disease and that aspirin may lower the risk without significant risk of bleeding. (The previous guidance didn’t address anyone younger than 50.) People ages 60 or older are now advised not to start taking aspirin to prevent first heart attacks or strokes.

The draft recommendations don’t apply to people who have already had heart attacks or strokes; the task force still recommends that they take aspirin preventively.

“For anyone who is on aspirin because they’ve already had a heart attack or stroke, it’s a very important medication,” said Dr. Erin Michos, an associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, who isn’t part of the task force.

Heart disease is the leading cause of death in the U.S., and according to the most recent data available, 29 million adults in the U.S. take aspirin daily to prevent heart disease even though they don’t have histories of it.

Aspirin acts as an anticoagulant, meaning it helps to prevent blood clots from forming. A clot that cuts off blood flow to the heart leads to a heart attack; one that cuts off blood flow to the brain causes a stroke. The idea behind taking a daily low-dose aspirin was to lower the risk of such clots, lowering the risk of heart attack or stroke.

But the same mechanism that lets aspirin prevent blood clots from forming can also increase a person’s risk of bleeding, because it prevents blood from clotting at the site of a wound.

Newer studies that informed the latest task force recommendations found that for most healthy people, the risk of bleeding caused by aspirin outweighs the benefits of preventing blood clots. For the same reason, the

What the latest COVID research says about breakthrough cases and transmission : Shots

October 14, 2021 Vera

Gloria Clemons gives a COVID-19 vaccine to Navy veteran Perry Johnson at the Edward Hines, Jr. VA Hospital in Hines, Ill., in September.

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Gloria Clemons gives a COVID-19 vaccine to Navy veteran Perry Johnson at the Edward Hines, Jr. VA Hospital in Hines, Ill., in September.

Scott Olson/Getty Images

Conventional wisdom says that if you’re vaccinated and you get a breakthrough infection with the coronavirus, you can transmit that infection to someone else and make that person sick.

But new evidence suggests that even though that may happen on occasion, breakthrough infections might not represent the threat to others that scientists originally thought.

Ross Kedl, an immunologist at the University of Colorado School of Medicine, will point out to anyone who cares to listen that basic immunology suggests the virus of a vaccinated person who gets infected will be different from the virus of an infected unvaccinated person.

That’s because vaccinated people have already made antibodies to the coronavirus. Even if those antibodies don’t prevent infection, they still “should be coating that virus with antibody and therefore helping prevent excessive downstream transmission,” Kedl says. And a virus coated with antibodies won’t be as infectious as a virus not coated in antibodies.

Scant evidence for easy transmission of breakthrough infections

In Provincetown, Mass., this summer, a lot of vaccinated people got infected with the coronavirus, leading many to assume that this was an example of vaccinated people with breakthrough infections giving their infection to other vaccinated people.

Kedl isn’t convinced.

“In all these cases where you have these big breakthrough infections, there’s always unvaccinated people in the room,” he says.

In a recent study from Israel of breakthrough infections among health care workers, the researchers report that in “all 37 case patients for whom data were available regarding the source of infection, the suspected source was an unvaccinated person.”

How A Gay Community Helped The CDC Spot A COVID Outbreak — And Learn More About Delta

It’s hard to prove that an infected vaccinated person actually was responsible for transmitting their infection to someone else.

“I have seen no one report actually trying to trace whether or not the people who were vaccinated who got infected are downstream — and certainly only could be downstream — of another vaccinated person,” Kedl says.

There’s new laboratory evidence supporting Kedl’s supposition. Initially, most vaccine experts predicted that mRNA vaccines like the ones made by Pfizer and Moderna that are

Transgender patients find health care on Rutgers student’s app

October 14, 2021 Vera

Imagine checking in for an appointment with your primary care doctor, and you notice your forms show the wrong gender marker. You might feel confused, hurt, question how well your doctor knows you or how to offer you proper care.

Transgender, nonbinary and other gender diverse people fear instances like this when they seek health care, like a nurse calling their wrong name or receiving incorrect treatment because of their outdated gender marker. Finding providers who know how to treat non-cisgender people would be ideal, but that’s not a simple feat.

Typing key words for transgender-affirming care in a search engine calls up LGBTQ-specific providers. It’s more difficult to find everyday health care services, like dentists or primary care doctors, who respect and understand gender diverse patients.

Creators behind an upcoming app, TranZap , want to make that search simpler for gender diverse people seeking care.

Gender-affirming providers are not only doctors who perform plastic surgeries or administer hormone replacement therapy. They’re doctors, nurses, front desk staff and everyone in a medical office who know how to respectfully care for gender diverse patients.

Second year Rutgers Robert Wood Johnson Medical School student Taylor Chiang is beta testing TranZap, an app that allows transgender people to review healthcare providers as a way to help other trans people find medical professionals who respect their identities. Chiang developed the app concept and is pictured with their mentor, Dr. Gloria Bachmann, a professor of Obstetrics & Gynecology and Associate Dean for Women Health at Rutgers Robert Wood Johnson Medical School.

Some resources exist that help transgender people find plastic surgeons or endocrinologists who affirm people’s gender physically. Taylor Chiang, a second year student at Rutgers Robert Wood Johnson Medical School who came up with TranZap, wants people to find “gender-affirming [providers] to get regular old routine care.”

“A big barrier to health care is being afraid that you’re going to be discriminated against or not knowing information,” Chiang said. “Whether or not a primary care provider is gender-affirming, that information is lacking.”

Transgender people face a high risk of physical and mental health problems, but are “consistently and systemically underserved by the American medical system,” a Center for American Progress report reads. Some 62% of transgender respondents said they worried about being judged based on their sexual orientation or gender identity in health care settings, according to TransPop survey results.

Second year Rutgers Robert Wood Johnson Medical School student Taylor Chiang, not pictured, is beta testing TranZap, an app that allows transgender people to review healthcare providers as a way to help other trans people find medical professionals who respect their identities.

Chiang experienced uncomfortable conversations surrounding their identity in health care settings before. They typically searched for providers who accepted their insurance, or heard about affirming providers via word of mouth. Sometimes, they “risked” the provider lacking knowledge about caring for and talking to transgender and gay patients.

They had connections to transgender people seeking similar care, but they wondered about gender diverse people who didn’t have that community, who struggled to find health care. That