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Let’s talk Medicare Advantage – NC Health News

March 20, 2023 Vera

By Thomas Goldsmith

Privately run Medicare Advantage insurers attract more enrollees each year with prominent advertising and enticing perks. But the program, with about 1 million North Carolina enrollees, faces challenges on specifics from federal regulators, the courts and Congress about the profits it makes, its consumer advertising and some of its internal practices.

As federal regulators are taking aim at aspects of Medicare Advantage, such as allegedly fraudulent billing practices, a report from the U.S. Senate Finance Committee is one of the sources that lists complaints calling its marketing misleading. Those problems have been seen in North Carolina, as well as across the country.

“The North Carolina Department of Insurance shared that its Seniors’ Health Insurance Information Program (SHIIP) had received a number of complaints involving dually eligible beneficiaries who had their enrollment changed to a different [Medicare Advantage] plan even though neither the beneficiary, family member, or power of attorney had been engaged in an enrollment discussion with the plan or an agent,” the August 2022 report reads.

(Dually eligible beneficiaries are eligible for Medicaid, the health insurance that covers low-income people, and for Medicare, which is mostly for people older than 65.)

Now, federal regulators are proposing new rules to curb such deceptive practices. Regulators say the rules are necessary to make sure potential Medicare Advantage customers can receive accurate information about the plans and their differences from traditional Medicare.

In addition to restricting the advertising that draws millions of enrollees to Medicare Advantage, the federal Centers of Medicare and Medicaid Services is working with the federal Department of Justice to crack down on billing practices that they contend can unnecessarily increase company profits by billions annually.

Recently announced moves by CMS to improve the accuracy of billing by Medicare Advantage companies won praise late last week in a joint letter from a group of more than three dozen leading figures from public health, public policy, health care and clinical care.

“CMS has taken a strong and appropriate approach to improving the accuracy of payment in the MA Program,” said Dr. Don Berwick, a former administrator of the Centers for Medicare and Medicaid Services who signed the letter.

Additional signers included faculty from Yale, Harvard, Stanford, Southern California, Pennsylvania and New York universities, as well as former officials of CMS, the Center for Medicare and Medicaid Innovation and the Medicare Payment Advisory Commission, known as MedPac,

Friday, February 10, 2023 | Kaiser Wellbeing News

March 7, 2023 Vera

Longer Looks: Attention-grabbing Reads You Could Have Missed

Just about every week, KHN finds for a longer time tales for you to appreciate. This week’s options include things like tales on students with disabilities, electronic scribes, metagenomic up coming-generation sequencing, sexual intercourse, and a lot more.

The New York Occasions:
How Educators Secretly Remove College students With Disabilities From School

Jessica LaVigne was anxious but hopeful on a the latest afternoon that the workforce controlling her son’s unique education program at Roseburg High University would notify her a thing she had dreamed of for more than a decade: He would be able to go to a complete working day of university for the first time due to the fact next quality. All through her son’s elementary yrs, Ms. LaVigne was called practically everyday to pick him up hrs early since he was obtaining “a poor working day.” By middle university, he was only attending an hour a day. By substantial university, he was informed he had to “earn” back again two course intervals taken off his schedule by proving he was academically and socially completely ready. (Environmentally friendly, 2/9)

Stat:
Mm-Hm, Uh-Huh: How Mumbling Trips Up ‘Digital Scribes’ For Doctors

“Your vision is great?” asked the health care provider. “Mm-hm,” replied the patient. “And your dentures fit wonderful?” “Yep,” the client explained. “No issues with them?” the health practitioner adopted up. “Mm,” the affected individual stated, indicating almost everything was Ok. The again-and-forth would have created ideal perception to the two folks speaking in the clinic. But to the computerized speech recognition resource tasked with transcribing it and turning it into take a look at notes, the “mm-hms” and mumbles grew to become a garbled mess. (Trang, 2/7)

The Wall Street Journal:
Even A Brain-Eating Amoeba Just cannot Disguise From This Chopping-Edge DNA Tech

When a middle-aged gentleman who had endured a seizure was admitted to the University of California San Francisco Health-related Center in 2021, medical practitioners seeking the cause for his ailment speedily grew to become stumped. Right after pathologists expended two weeks peering through microscopes and monitoring petri dishes, medical doctors knew a thing serious was harming the patient’s mind they experienced no notion what it was or how to handle it. (Winslow, 2/8)

The New York Situations:
The Indicate Everyday living Of A ‘Midsize’ Model

In Paris final thirty day period, at the Chanel couture show,

COVID, Mpox, Misinformation: The Way Forward for General public Well being | Healthiest Communities Well being News

February 5, 2023 Vera

The not long ago concluded year was one particular rife with issues but also signs of guarantee for the nation’s community overall health workforce.

Individuals in the subject can glance back again on a 2022 that observed continued COVID-19 exercise merged with other respiratory menaces – particularly, an early resurgence of influenza and circumstances of RSV that have strained clinic potential.

In the meantime, wellbeing departments experienced to facial area added threats normally extra distant to Individuals. Considering the fact that the initially scenario of mpox, formerly identified as monkeypox, in the state was documented in May well, virtually 30,000 folks have contracted the ailment and 20 have died. A latest measles outbreak in Ohio and the 1st identified case of polio in the U.S. in virtually a decade also stored the nation’s currently overburdened community health community on inform.

“This year in unique, what’s happened in community wellness confirmed us the hazards of ongoing threats from close to the globe,” claims Lori Freeman, CEO of the Nationwide Affiliation of County and Metropolis Wellness Officials.

Throughout the U.S., all those concerns have been compounded by enhanced general public scrutiny of health officials and their function, as nicely as an erosion of believe in in the institutions they represent.

Polling from the Robert Wooden Johnson Basis and the Harvard T.H. Chan University of Community Overall health found that 52% of Us residents in early 2021 said they experienced “a fantastic deal” or “quite a lot” of trust in tips from the Centers for Ailment Management and Prevention, although only 37% reported the exact same concerning the National Institutes of Well being and the Foodstuff and Drug Administration. Only 44% of Individuals claimed they experienced a good deal of rely on in their neighborhood overall health department, and 41% shared the identical sentiment about their state well being department.

Survey outcomes released in February by the Pew Investigate Centre located that the share of American grownups who claimed they had “a fantastic deal” of self-confidence in healthcare scientists to act in the most effective passions of the community fell from 43% in April 2020 to 29% in December 2021. Pew polling also discovered that only 52% of grownups this past May believed community wellness officers like these at the CDC have been undertaking an great or great work responding to COVID-19, down from 79% in March 2020.

“Trust in govt was low

good health news from across the world

January 8, 2023 Vera

^{In 2022, Vanuatu eliminated trachoma, the world’s leading infectious cause of blindness. Above, a young student in Rangusuksuk, Pentecost Island. ©UNICEF/Bobby Shing}

This year, WHO worked with countries and other partners to fight outbreaks and eliminate diseases, while building toward the goal of health for all.

We have selected a few news items from countries as 2022 bright spots:

Milestones: Malawi and Vanuatu eliminate blinding eye infection

^{Trachoma infection mainly affects children in underserved, remote rural communities. Above: children in Malawi. ©WHO}

In 2022, Malawi became the first country in Southern Africa to eliminate trachoma, and Vanuatu became the first Pacific Island country to do so.

“This is a proud moment for Vanuatu,” said Minister of Health Bruno Leingkone. “This combined effort has already saved hundreds of people from lifelong blindness.”

Malawi’s success is the culmination of its multi-pronged Trachoma Action Plan, launched in 2014 and supported by donors, among them Sightsavers and the Queen Elizabeth Diamond Jubilee Trust.

The two countries join 13 others in the achievement: Cambodia, China, Iran, Lao People’s Democratic Republic, Gambia, Ghana, Mexico, Morocco, Myanmar, Nepal, Oman, Saudi Arabia and Togo.

^{Trachoma is the second neglected tropical disease to be eliminated in the archipelago nation of 83 islands, after lymphatic filariasis in 2016. Above: students on Pentecost Island. ©UNICEF/Bobby Shing}

See more about Malawi and
Vanuatu

Related news: WHO Director-General congratulates Togo on becoming the first West African country to eliminate four neglected tropical diseases

Orinoco expedition brings vital health services deep into the Amazon

The Pan American Health Organization (PAHO) makes three boat excursions a year deep into Venezuela’s rainforest to bring vaccinations and other health services to 22 indigenous ethnic groups.

On its September trip, the PAHO team reached 126 communities and administered thousands of vaccinations for polio, measles/rubella and COVID-19.

“Most people don’t know that inside Venezuela there are communities that are eight days’ travel away (from health services),” said Vicente Baretta, who supported PAHO in the expedition. “Organizing a journey like this presents problems
that cannot be imagined from the outside, such as the need to buy new freezers for each trip, because fifteen days spent wobbling around in a boat usually renders them unfit for use again.”

Some successes in 2022 from WHO’s Eastern Mediterranean region

^{A boy displaced by floods in Pakistan visits}

Tuesday, November 22, 2022 | Kaiser Health News

December 12, 2022 Vera

Health Systems, Patient Care Impacted By Rising Claim Denial Rates

Modern Healthcare draws attention to a “significant” rise in denied insurance claims over the past year, which has increased administrative work, reduced hospital cash flow, and delayed patient care. Separately, Axios reports on how medical inflation is affecting big employers.

Modern Healthcare:
Insurance Claim Denial Rates Rising As Health Systems Struggle

Health systems across the country have experienced a significant rise in denied claims over the past year, leading to more administrative work for providers, less cash flow for hospitals and, in some cases, postponed patient care. (Devereaux, 11/21)

Ashburn mom finds a healthy new lifestyle after joining a local gym | News

December 7, 2022 Vera

As a busy mother of three children with a husband who served in the military, like many mothers, Ingrid Herrera-Yee of Ashburn often finds that it is difficult to prioritize her own health and fitness needs.

Last year, Herrera-Yee, 54, said she had high blood pressure and high cholesterol levels and was on the obese side of the body mass indicator (BMI) chart.