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Surprise billing lawsuit from Texas doctors

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The Texas Medical Association filed its second lawsuit Thursday challenging the federal government’s surprise billing process.

A august rule independent dispute resolution for contingent medical bills still unlawfully favors insurers over providers, the Medical Association claims in its complaint in the US District Court for the Eastern District of Texas.

“We again demand that the law be obeyed as Congress intended and that the contested provisions be void. Physicians and healthcare providers should have a level playing field in payment disputes after caring for patients,” said Texas Medical Association President Dr. Gary Floyd, in a press release.

The lawsuit comes right after the American Medical Association and the American Hospital Association dropped their legal challenges to politics. The AMA and AHA support the Texas lawsuit. “We intend to make our voice heard in this case by filing an amicus brief explaining how the final rule differs from Congress’ intention, just like the September 2021 interim final rule,” the organizations said in a joint statement on Thursday.

The Texas Medical Association first sued regulators over arbitration last year. The interim rule required the arbitrators to select the surprise bill payment offer that came closest to the median of the in-network rate contracted by the insurer. Judge Jeremy Kernodle of the US District Court for the Eastern District of Texas decided in favor of Texas doctors in February.

The federal government appealed the decision in April, but subsequently established a rule requiring arbitrators to consider both the median of an insurer’s contracted in-network rate and additional information when deciding whether to pay a surprise bill.

The Texas Medical Association claims the final rule does not go far enough to protect provider payments. The method used to calculate insurers’ median in-network rates is “deflated” compared to insurers’ actual average contract rates, the group argued in the press release.

“These provisions of the final rule are manifestly unlawful and unfairly distorted [independent dispute resolution] Results in favor of insurers, giving them a stroke of luck that they could not achieve in the legislative process. At the same time, they undermine the ability of healthcare providers to receive fair compensation for their services, to the detriment of both providers and the patients they serve,” the complaint reads.

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The HCD 10: Kimberly Cowman, Building Professional

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After 17 years leading engineering teams focused on healthcare, Kimberly Cowman was promoted to her current position as National Director of Engineering at in 2019 Leo A Daly. This role gave her the opportunity to further pursue her career-long passion and professional mission of increasing awareness and acceptance of sustainability and high-performance design in healthcare and beyond.

She believes that healthcare has not only an opportunity but also a responsibility to transform the way its buildings function and lead the way in creating more sustainable and healthier places.

“As designers, we not only have a direct impact on the climate-related outcomes of communities, but also on the health outcomes of the people who inhabit healthcare facilities,” she says.

For example, in 2021, Cowman helped found Leo A. Daly’s enterprise-wide Design Integration Group (DIG), which strives to drive an integrated design agenda focused on high-performance building outcomes. The group’s efforts include cross-sector benchmarking, including two major hospital projects: Veterans Hospital in Tulsa (VHiT) in Tulsa, Okla. and St. Francis Hospital in Muskogee, Okla. Integrated design workshops involving representatives from across the design team and different design disciplines were brought together for each of these projects to identify performance targets such as: B. for the energy consumption intensity (EUI), and to find design strategies that could lead to a more efficient design.

These efforts included considerations of thermal comfort, site community, daylight supply, and indoor air quality, among others. Cowman believes that by working to develop a design culture around interdisciplinary solutions, the industry can make greater strides toward achieving goals related to energy conservation, carbon reduction and healthier indoor environments.

In the meantime, she frequently offers her knowledge to help advance the industry through publications, speaking engagements, and more. Her recent work includes the white paper, Raising indoor climate to reduce the spread of pathogens, which explores new approaches in building design to slow the spread of COVID-19 and other airborne pathogens, and outreach to promote Energy Star adoption indicates certification in healthcare facilities.

Cowman advocates Energy Star certification in healthcare facilities to address a facility’s operational energy impact and to focus on finding efficiency opportunities throughout a building’s operating life.

click here to learn more about all winners of the HCD 10 2022.

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High-cost travel nurse contracts targeted in new Michigan bill

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Minnesota and Massachusetts are the only two states that have statutory caps on travel nurse rates.

Minnesota law, passed in 2001, prohibits an agency from charging more than 150 percent of an employee’s average hourly wage in that role. During the pandemic, the state allowed agencies to request wage cap waivers. Massachusetts has an overarching anti-price gouging law that applies to services like nursing agencies, but in May 2020 the cap agencies could charge was raised by 35 percent.

Several other states, including Pennsylvania, Illinois and Connecticut, are considering similar legislation. And hospital and nursing home associations are putting pressure on lawmakers.

In February, the AHA and 200 others urged the US Congress to use its federal powers to investigate travel nursing agencies for “price gouging” and other anticompetitive practices.

“The conduct of some of these recruitment agencies bears all the hallmarks of widespread collusion and perhaps other abuses,” the letter said. “Preventing staffing agencies from exploiting hospitals and healthcare systems’ need for providers would help alleviate some of the financial and operational strains hospitals are currently facing and allow them to remain focused on the critical care of patients. “

The Michigan Health and Hospital Association supports the proposed Michigan legislation.

“The MHA supports HB 6364 because it would help address exorbitant contract labor costs that threaten the financial sustainability of hospitals,” reads a statement on its website.

According to a recent report by McKinsey & Co., healthcare systems believe the financial viability of their entire industry is at stake amid a projected shortage of 450,000 registered nurses in the next three years alone. We do not want or cannot compete with travel nursing agencies. There are fears of too many patients, too few nursing staff and ultimately a reduction in the quality of care.

“We’re seeing double-digit increases in costs in long-term care facilities, and wages are the primary reason for that,” Samuel said. “Recruitment agencies are just part of that picture, but it’s just not sustainable. We must do everything we can to attract workers back to the sector and we cannot do that at this cost.”

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CDC: early figures show unvaccinated at much higher risk for monkeypox

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According to preliminary data released Wednesday by the Centers for Disease Control and Prevention (CDC), people who were eligible for a monkeypox vaccine but didn’t receive one were about 14 times more likely to be infected than those those who have been vaccinated.

Although extremely limited, the numbers offer a first glimpse of the real-world effectiveness of the Jynneos vaccine.

“These new data give us a degree of cautious optimism that the vaccine is working as intended,” CDC Director Rochelle Walensky told reporters.

But the numbers are based on data collected from just 32 states, and there’s no way to distinguish how much of the drop in cases is due to the vaccine alone and how much is due to behavioral changes in the most vulnerable populations.

The data is also based on people who received only a single dose of the vaccine. Relatively few people in the current outbreak have completed the recommended two-dose series, according to the CDC.

Infections continue to fall week by week, but there are currently more than 25,000 cases of monkeypox identified in all 50 states.

Health officials have seen protection from monkeypox for those vaccinated with Jynneos as early as two weeks after the first dose, Walensky said. However, she said laboratory studies show that immune protection is highest two weeks after the second dose of the vaccine, which is why they continue to strongly recommend people to get two doses of Jynneos 28 days apart.

“What we have at the moment is data on how well our vaccine works after a single dose. What we don’t know yet is what happens after a second dose and how durable that protection is,” Walensky said.

In addition to the initial numbers, health officials said Wednesday they are expanding eligibility for the Jynneos vaccine by moving to a pre-exposure prophylaxis strategy.

The new strategy “encourages vaccine providers to minimize the risk assessments of people seeking the vaccine. Fear of disclosure of sexuality and gender identity must not be a barrier to vaccination,” said Demetre Daskalakis, White House adviser on monkeypox.

Daskalakis said people who may be currently or in the future at risk are now eligible, including: gay, bisexual and other men who have sex with men; Transgender or gender-matched individuals who have had more than one sex partner in the past six months; Have had sex in a location associated with a higher risk of monkeypox or have been diagnosed with a sexually transmitted infection in the past six months.

The strategy also extends vaccines to sexual partners of at-risk individuals and commercial sex workers, Daskalakis said.

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