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May 02, 2020 01:00 AM

Letters: Business as usual for healthcare payers?

Modern Healthcare
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    Man providing insurance card to healthcare provider
    Modern Healthcare Illustration / Getty Images

    As health system employees and doctors place themselves in danger for patients and their organizations hemorrhage cash during the COVID-19 pandemic, it appears to be business as usual for most payers.

    Health plans continue to distract providers with valueless administrative hassles, including ever-increasing pre-authorization requirements, denials, down-coding algorithms and the threat of retrospective review. As some health plans report record profits, there is no indication that the payers will provide any financial relief to physicians or hospitals during this crisis.

    For example, at the peak of the COVID-19 crisis, a Southeastern health system had no choice but to settle its negotiations with a Blues plan at no increase for the next few years to get the plan to release its multimillion-dollar quality bonus. One of the largest for-profit payers is reportedly taking advantage of the surprise billing legislation by offering hospital-based physician groups absurd rate reductions, knowing the groups will go out of network and thus forcing the groups to the state-mandated median-fee schedule.

    The health plans promote their coverage of COVID-19 cases with no copays or deductibles. But they fail to mention that 68% of the commercial lives in this country are covered by employers’ self-funded plans, so the waived copays and deductibles are paid by the employers, not the health plans. And one can only guess the windfall profits the health plans are amassing as a result of video office visits versus in-person visits, unused funds earmarked for elective procedures, and grossly underutilized hospital services.

    The leadership of America’s Health Insurance Plans has recognized caregivers and health systems as heroes in this war on COVID-19. Contrary to their PR and rhetoric, the health plan industry has not shown solidarity with doctors and hospitals in a meaningful way; it’s time that they do. The healthcare world has changed; why won’t they?

    Nathan Kaufman
    Managing director
    Kaufman Strategic Advisors
    San Diego

    State compacts, not national licenses, are the answer

    The April 13 guest expert “Pandemic proves urgent need for national practitioner licensing system” failed to mention the Interstate Medical Licensure Compact. Launched in 2014, this voluntary agreement between (thus far) 29 states, the District of Columbia and Guam provides an expedited pathway for physicians to obtain multiple licenses while preserving state regulation of medicine, which is a key tenet of federalism. The compact facilitates telemedicine and enables physician mobility, both during and outside of crises.

    Rather than advocating federal licensure, the authors would do better to urge their home state of Pennsylvania to join the compact, which was passed by the Legislature in 2016 but never implemented by the governor.

    Charles G. Kels
    San Antonio

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