Blog Posts & Comments

As I read your final blog and also read the posts that others wrote on your blogs, please take some time to reply to their comments and questions.  It's not a grade, per se, but given all the work you put in to your blog and final blog, it is a good way to learn from what others posted and have a chance to respond.  

So please, after you are done with the final, take a minute to read others' comments.   

Thank you all for great work on your blogs, and for your comments.   

MACRA may not survive the Trump Administration

The headline read, "Tom Price Is A Sharp Critic Of Obama-Led Shift Toward Value-Based System For Medicare. Yes, the Health and Human Services Department secretary says the move could undermine the traditional doctor-patient relationship.

The Obama administration and congressional Republicans and Democrats took added steps in 2015 that potentially could discourage overbilling and other fraudulent activities by changing the way doctors are reimbursed for their services. The Medicare Access and CHIP Reauthorization Act (MACRA) was designed to shift the medical system away from tradition “fee-for-service” and towards rewarding the quality of service in a bid to save hundreds of billions in the coming decades. But while the Obama administration took an important step last October by issuing the proposed new regulations to implement the law, they could be stopped in their tracks under the new Republican leadership at HHS.

Surprised? My guess is that an executive action cannot stop this, but who knows. 

No Deal Between United Healthcare and Northwest Hospital

As of today, May 1, Northwest Healthcare is no longer in UnitedHealthcare's network - a contract termination that will affect thousands of Tucson area patients.   As has been the case throughout the dispute, each side had its own version of what happened.

The end of the contract means patients covered by UnitedHealthcare will no longer be able to use Northwest Medical Center and Oro Valley Hospital, except for emergencies. They will also no longer be able to have visits to Northwest Allied Physicians and Northwest Healthcare urgent care centers, among others, covered by their insurance.

A contract termination affects UnitedHealthcare’s Medicaid, Medicare Advantage, individual and employer-sponsored plans (but not MediGap plans). UnitedHealth officials last week said they already had a transition-of-care plan in case the contract wasn't resolved.

Both sides of the dispute have written newspaper op-eds, as well as letters to patients (see below). Northwest Healthcare said it sent out more than 60,000 letters to UnitedHealthcare patients who had used a Northwest facility in the last year. It also set up a website called Stand Up to United Az.

Some Background

According to an opinion in the local paper, the CEO of Arizona Health Plans of United Healthcare,
Dave Allazetta, claimed that 

UnitedHealthcare wants nothing more than to continue our relationship with Northwest. In fact, we are offering to reward Northwest [Hospital] for the important services it provides to our members in Southern Arizona if the health-care system will commit to a value-based care model. Simply stated, value-based care means a portion of the health-care system’s payments from UnitedHealthcare would be based on how it performs against key quality measures and improved health outcomes for its patients.

Here is a link to this opinion as well as from Northwest's point of view, and about the anxiety created for patients in NW Tucson if United Healthcare leaves Northwest Hospital.

It might be worth investigating what United Healthcare means by "a value-based care model." But obviously it seems much more complex than what is offered by United Healthcare. Given that Northwest Healthcare is owned by Tennessee-based Community Health Systems, it ultimately came down to them.