sup, sub { font-size: 100% !important; } sup { mso-text-raise:10% } sub { mso-text-raise:-10% }
Click in for more news from The Hill
{beacon}
Health Care
Health Care
<!–
The Big Story
AARP endorses bill to prevent upcoding in Medicare Advantage
The senior interest group is putting its backing behind bipartisan legislation aimed at preventing the practice of upcoding in Medicare Advantage, when healthcare providers bill for inaccurate codes to increase their reimbursement.
In a statement Thursday, AARP noted that upcoding is expected to increase care costs for Medicare Advantage enrollees by $40 billion this year.
The No UPCODE Act was introduced by Sens. Bill Cassidy (R-La.) and Jeff Merkley (D-Ore.) earlier this year. The bill would disincentivize upcoding by developing a risk-adjustment model using two years of diagnostic data as opposed to one, limiting the use of unrelated medical conditions when estimating the cost of care, and bridging the gap between how patients on Medicare Advantage and traditional Medicare are assessed.
In a letter to Cassidy and Merkley, AARP senior vice president for government affairs Bill Sweeney wrote, “While many Medicare beneficiaries appreciate the flexibility and ease of use that MA provides, we are concerned that upcoding leads to both inflated payments to insurance plans and higher premiums for American seniors.”
“These resources would be better spent strengthening Medicare, such as by providing dental, hearing, and vision coverage,” Sweeney added.
“This bill addresses a problem both Republicans and Democrats have labeled as waste, fraud, and abuse. AARP agrees the No UPCODE Act protects seniors by preserving benefits and eliminating waste,” Cassidy said in a statement Thursday. “When companies upcode, taxpayers foot the bill and patients get nothing. That’s wrong.”
While the Trump administration has railed against waste, fraud and abuse in Medicare and Medicaid, the vast majority of Medicare payments are made properly.
As KFF found in its analysis of fiscal year 2024 payments, 94.4 percent of Medicare Advantage payments were made properly, with improper Medicare payments totaling $54.3 billion.
Health Secretary Wes Streeting is promising to keep NHS services running as a five-day walkout by resident doctors gets underway in England.
He said the disruptionwould be kept to a minimum after NHS England ordered hospitals to only cancel treatments in exceptional circumstances.
In previous strikes, the focus has been on staffing emergency care but this time the NHS is strivingto keep non-urgent services running. Senior doctors are covering resident doctors – the new term for junior doctors who are striking – for the 12th time in the pay dispute.
The British Medical Association warned that this risks stretching staff too thinly, saying ministers had every opportunity to stop the walkout.
Despite the efforts being put in by NHS leaders, he said the walkout would cause a “huge loss for the NHS and the country,” as he criticised the British Medical Association (BMA) for “rushing” into strikes.
Sir Keir said the walkouts threatened “to turn back the clock on progress we have made in rebuilding the NHS over the last year”.
Streeting said: “There is no getting around the fact that these strikes will hit the progress we are making on turning the NHS round.”
But he added: “I am determined to keep disruption to patients to a minimum.”
Members of the public have been urged to come forward for NHS care during the walkout, and are being asked to attend appointments unless told they are cancelled.
GP surgeries will open as usual, and urgent care and A&E will continue to be available, alongside NHS 111, NHS England said.
The strike is going ahead after talks between the government and BMA broke down on Tuesday.
Those talks were focused on non-pay issues, such as the cost of exam fees and career progression, after Streeting had said pay was not open to negotiation.
The BMA says, despite a 5.4% average pay rise this year following a 22% increase over the previous two years, pay is still down by a fifth since 2008, once inflation is taken into account.
During their first foundation year after finishing their medical degree resident doctors in England now earn a basic salary of £38,831, for an average of 48 hours worked per week. In the second year, this rises to £44,439. By the end of training salaries exceed £73,000.
Medics are often expected to work nightshifts, weekends and longer hours for extra payments. On average these top up their earnings by more than a quarter.
BMA resident doctor co-leaders Dr Melissa Ryan and Dr Ross Nieuwoudt said: “Resident doctors are not worth less than they were 17 years ago.
“Restoring pay remains the simplest and most effective route toward improving our working lives.
“Mr Streeting had every opportunity to prevent this strike going ahead, but he chose not to take it.”
Previous walkouts have led to mass cancellations, with more than one million appointments and treatments cancelled during resident doctor strikes which first began in March 2023.
Some hospitals were only able to deliver half their normal amount of routine care on strike days.
But NHS sources said, this time, some hospitals were planning full schedules after the new approach of prioritising both emergency and non-urgent care.
“We’ve learnt lessons from the past strikes – this one will feel very different,” they added.
Prof Meghana Pandit, a director at NHS England, said: “It’s really important to reduce cancellations, because people have been waiting, sometimes for months for their routine hip replacement or hysterectomy or any appointment, and actually rescheduling the appointments impacts on them and leads to physical and psychological harm.”
But she said it was inevitable there would still be some disruption, however she warned patients to still use the NHS if they need it.
While the majority of resident doctors work in hospitals, some GP practices and community services could also be affected. Resident doctors represent nearly half the medical workforce.
One of those who has been impacted is Hassnain Shahid, 32, from Bradford, whose three-year-old daughter has had her lung surgery on Monday cancelled.
She has a rare lung condition which means that if she catches a cough or cold she could be at serious risk.
“It’s been an emotional rollercoaster. It’s very frustrating,” said Hassnain.
The BMA, though, has warned the new approach could cause even greater problems and risk safety.
It has written to NHS England to say that staff who are working could be stretched too thinly. The union said it would be better to significantly reduce non-urgent care as has happened previously.
But Saffron Cordery, deputy chief executive of NHS Providers, which represents hospitals, said while hospitals were going to be trying to keep services running this would be done within “rigorous safety guidelines”.
She said the situation was complicated by the fact that doctors were not obliged to say whether they would be turning up or not.
“Nobody will know until they actually turn up for their shifts or not.”
Around two thirds of resident doctors are BMA members.
Conservative shadow health secretary Stuart Andrew said the strikes threatened to drag hospitals into chaos and leave patients “dangerously exposed”.
“Labour’s spineless surrender to union demands last year opened the door to this.
“They handed out inflation-busing pay rises without reform and now the BMA is back for more.”
But Rory Deighton, of the NHS Confederation, which represents frontline health managers, said: “The impact of these strikes and the distress they will cause patients rests with the BMA.”
sup, sub { font-size: 100% !important; } sup { mso-text-raise:10% } sub { mso-text-raise:-10% }
Click in for more news from The Hill
{beacon}
Health Care
Health Care
<!–
The Big Story
AARP endorses bill to prevent upcoding in Medicare Advantage
The senior interest group is putting its backing behind bipartisan legislation aimed at preventing the practice of upcoding in Medicare Advantage, when healthcare providers bill for inaccurate codes to increase their reimbursement.
In a statement Thursday, AARP noted that upcoding is expected to increase care costs for Medicare Advantage enrollees by $40 billion this year.
The No UPCODE Act was introduced by Sens. Bill Cassidy (R-La.) and Jeff Merkley (D-Ore.) earlier this year. The bill would disincentivize upcoding by developing a risk-adjustment model using two years of diagnostic data as opposed to one, limiting the use of unrelated medical conditions when estimating the cost of care, and bridging the gap between how patients on Medicare Advantage and traditional Medicare are assessed.
In a letter to Cassidy and Merkley, AARP senior vice president for government affairs Bill Sweeney wrote, “While many Medicare beneficiaries appreciate the flexibility and ease of use that MA provides, we are concerned that upcoding leads to both inflated payments to insurance plans and higher premiums for American seniors.”
“These resources would be better spent strengthening Medicare, such as by providing dental, hearing, and vision coverage,” Sweeney added.
“This bill addresses a problem both Republicans and Democrats have labeled as waste, fraud, and abuse. AARP agrees the No UPCODE Act protects seniors by preserving benefits and eliminating waste,” Cassidy said in a statement Thursday. “When companies upcode, taxpayers foot the bill and patients get nothing. That’s wrong.”
While the Trump administration has railed against waste, fraud and abuse in Medicare and Medicaid, the vast majority of Medicare payments are made properly.
As KFF found in its analysis of fiscal year 2024 payments, 94.4 percent of Medicare Advantage payments were made properly, with improper Medicare payments totaling $54.3 billion.
Whittaker is a former UFC middleweight champion who has won 17 of his 23 fights since joining the promotion in 2012.
He is currently fifth in the UFC’s middleweight rankings, demonstrating sporting longevity at the top which is matched by few.
Although Whittaker says regaining the title – which he lost to Israel Adesanya in 2019 and is now held by Du Plessis – remains a goal, it his not his biggest driver any more.
“I’ve got nothing to prove, there’s just things that I’m working for. I’m leading by example for my kids and any other athlete that wants to look up to me,” says Whittaker.
“I’ve been in the game so long, what drives me to be better and push as hard as I do, is the kids.”
De Ridder is fighting in only his fourth UFC bout after joining the organisation last year.
He is 34 like Whittaker, but has spent much of his career in fellow MMA promotion One Championship, where he is a former middleweight and light-heavyweight champion.
“De Ridder is going to be looking to pressure me and take me down to the ground and make me uncomfortable,” said Whittaker.
“I want to get my hands on him and hope for a quick one but I’ve been training for a 25-minute slugfest.”
sup, sub { font-size: 100% !important; } sup { mso-text-raise:10% } sub { mso-text-raise:-10% }
Click in for more news from The Hill
{beacon}
Health Care
Health Care
<!–
The Big Story
AARP endorses bill to prevent upcoding in Medicare Advantage
The senior interest group is putting its backing behind bipartisan legislation aimed at preventing the practice of upcoding in Medicare Advantage, when healthcare providers bill for inaccurate codes to increase their reimbursement.
In a statement Thursday, AARP noted that upcoding is expected to increase care costs for Medicare Advantage enrollees by $40 billion this year.
The No UPCODE Act was introduced by Sens. Bill Cassidy (R-La.) and Jeff Merkley (D-Ore.) earlier this year. The bill would disincentivize upcoding by developing a risk-adjustment model using two years of diagnostic data as opposed to one, limiting the use of unrelated medical conditions when estimating the cost of care, and bridging the gap between how patients on Medicare Advantage and traditional Medicare are assessed.
In a letter to Cassidy and Merkley, AARP senior vice president for government affairs Bill Sweeney wrote, “While many Medicare beneficiaries appreciate the flexibility and ease of use that MA provides, we are concerned that upcoding leads to both inflated payments to insurance plans and higher premiums for American seniors.”
“These resources would be better spent strengthening Medicare, such as by providing dental, hearing, and vision coverage,” Sweeney added.
“This bill addresses a problem both Republicans and Democrats have labeled as waste, fraud, and abuse. AARP agrees the No UPCODE Act protects seniors by preserving benefits and eliminating waste,” Cassidy said in a statement Thursday. “When companies upcode, taxpayers foot the bill and patients get nothing. That’s wrong.”
While the Trump administration has railed against waste, fraud and abuse in Medicare and Medicaid, the vast majority of Medicare payments are made properly.
As KFF found in its analysis of fiscal year 2024 payments, 94.4 percent of Medicare Advantage payments were made properly, with improper Medicare payments totaling $54.3 billion.
Crude oil futures pull up from earlier lows, but not enough to avoid a fourth consecutive session of losses with prices consolidating as the market awaits more clarity on the outcome of U.S. tariffs and sanctions against Russia.
WTI was supported by the EIA’s report of a 3.2 million barrel crude oil inventory draw for last week, while a second large weekly build in diesel stocks eased some of the concerns about low supplies of the fuel.
WTI settles down 0.1% at $65.25 as September takes the front month position. Brent slips 0.1% to $68.51 a barrel.
Cherylee Barker has used preloaded cash cards for almost six years and says they help with the high cost of gluten-free foods, but do not cover the full cost
People in Wales who cannot eat gluten will be given debit-style cards preloaded with money to help pay for their food.
The UK-first move, which begins later this year, will be an alternative to the current system where those with conditions such as coeliac disease – which affects about one in 100 people – get food on prescription from the pharmacy.
Coeliac Cherylee Barker, 54, from Narberth, Pembrokeshire, took part in a pilot scheme and got £14 a month, which she said “scratches the surface of the cost”.
A Coeliac UK report said a gluten free diet added 35% to food bills and Health Minister Jeremy Miles said the Welsh government wanted to “de-medicalise the supply of gluten-free foods”.
The new card will work like a chip and Pin bank card and be taken in most places that sell gluten-free food, including supermarkets, shops, community pharmacies and online stores, according to the Welsh government.
It would not say how much people will be given – just that it will vary by person and be regularly reviewed – or how much would be spent on the scheme.
Ministers anticipate it will be “cost neutral” and not add any more to the NHS budget.
The prescription model will still be available in Wales, which is similar to schemes in England, Scotland and Northern Ireland.
Those with coeliac disease cannot eat gluten as their immune system attacks their own tissues and their body cannot properly take in nutrients.
It results in symptoms including bloating, vomiting and diarrhoea.
There is also an added cost . with gluten-free food more expensive Tesco, Asda, Sainsbury’s and Morrisons, the four leading supermarkets.
The average price of a own brand loaf of bread was 63p, compared with £2.26 for a gluten-free equivalent.
Supermarket penne pasta averaged 56p per 500g whereas the lowest gluten-free option averaged £1.22.
Ms Barker has been part of the pilot scheme in the Hywel Dda health board area for the past five years.
She gets £42 every three months, which equates to £14 a month, and described the previous prescription system as “slightly embarrassing” and the food “not that edible”.
She said: “I didn’t want to take the money from the NHS. I thought ‘just suck it up and see’ but after a little while I just found it was just becoming more and more expensive.
“It isn’t a lifestyle choice, it is a need.”
Despite saying the card was “fantastic” she said the amount she got was only “scratching the surface” of rising costs for everybody, especially coeliacs.
Bethan Williams says having to “budget for bread” can be damaging to people’s health
Bethan Williams, 24, from Cardiff, said prescriptions did not work for her as the food was low quality.
As a vegetarian, she said the cash cards could give people with additional dietary needs the freedom to make healthy choices.
“I am in a good position that I can afford the higher quality bread but that is not the case for all people,” she said.
“Eating food and being able to eat a balanced diet isn’t a privilege, it’s something everyone should be entitled to.”
Gemma Beere from Plumvanilla cafe says businesses need to weigh up supporting the community with high costs
For businesses such as Plumvanilla Cafe and deli in Narberth, which accepts the cash card, making sure they can serve the community’s needs is becoming more necessary.
Gemma Beere, who works at the cafe, said: “We’ve noticed more and more people shopping with gluten-free requirements so we like to keep a big stock.”
But she added it was a challenge balancing stocking the shelves with the high cost items and making sure nothing goes to waste.
Miles said the move would cut “administrative burdens on GPs and pharmacies”.
He added: “For people living with coeliac disease, following a strict gluten-free diet is not a lifestyle choice but a medical necessity.
“We want to de-medicalise the supply of gluten-free foods in Wales, giving people more freedom to access the food they want to eat, more conveniently, to help them to manage their condition.”
Tristen Humphreys from Coeliac UK said: “We need to recognise that a gluten-free diet is the treatment for coeliac disease, it’s a serious autoimmune disease not a lifestyle choice – we want that recognised.”
He added supporting people’s diets would help prevent health complications down the line and was “cost efficient” for the NHS and called on other UK nations to follow suit.
Liberal Supreme Court Justice Elena Kagan said Thursday that threats against judges should stop and emphasized that judicial orders “need to be respected.”
“That’s just not the way our system works, not the way rule of law in this country works. That’s true for the Supreme Court, and it’s also true for every district court. Unless and until an appellate court or the Supreme Court says otherwise, judicial orders are judicial orders and need to be respected,” Kagan said at a judicial conference in Monterey, Calif., according to multipleoutlets.
Kagan, one of the three liberal jurists on the nation’s highest court, advised judges not to be “aggravated or maddened” by the criticism they face over their rulings.
“The response to perceived lawlessness of any kind is law, and the way an independent judiciary should counter assaults on an independent judiciary is to act in the sorts of ways that judges are required to act,” the associate Supreme Court justice said.
President Trump, administration officials and their allies have slammed judges as unfair and at times “radical” when courts would not rule in their favor, particularly on the topic of immigration. Trump argued in May that the judge who ruled to pause the deportation of Venezuelan migrants under the 1798 Alien Enemies Act should be “IMPEACHED!!!”
Supreme Court Chief Justice John Roberts, in a rare statement, rebuked the president.
“For more than two centuries, it has been established that impeachment is not an appropriate response to disagreement concerning a judicial decision,” Roberts said.
“The normal appellate review process exists for that purpose,” Roberts added.
The U.S. Marshals Service has warned some federal judges earlier this year about an increase in threats against them.
“Judges are fair game for all kinds of criticism, strong criticism, pointed criticism, but vilifying judges in that way is a step beyond and ought to be understood as such,” Kagan said on Thursday.
