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Staffing Agencies Drive Up Costs For Health Facilities
Pennsylvania Hiker Dies In White Mountains
Trump Faces Mandatory Five-Year Sentence In Georgia
It is well-known that Americans pay more for health care than people in other developed countries, and many people blame it on the hospitals and doctors who take their money. However, an investigation by ProPublica shows that a hidden charge by insurance companies also contributes to that high cost.
The nonprofit news agency reports that “the shift from paper to electronic processing, which began in the early 2000s and accelerated after the Affordable Care Act went into effect, was intended to increase efficiency and save money. The story of how a cost-saving initiative ended up benefiting private insurers reveals a lot about what ails the U.S. medical system….”
We all know that insurers have slashed their reimbursement rates, forcing providers to exclude patients from their provider networks and forcing patients to spend extra time seeking pre-authorizations for ever more procedures and battling denials of coverage. However, doctors themselves have been hit by processing fees for the insurance payments they do receive. Almost 60% of medical practices reported in 2001 that they were compelled to pay fees for electronic payment at least some of the time, and the frequency has increased since then, according to medical facilities. With more than $2 trillion in medical claims being paid electronically each year, those fees likely add up to billions of dollars annually — money that otherwise could lower medical costs.
The Centers for Medicare & Medicaid Services posted a notice in August 2017 that informed insurance companies that they could not charge a fee to reimburse physicians for their work. Six months later, that statement disappeared without explanation and ProPublica learned that the decision-maker was not a CMS official but, rather, the chief lobbyist for Zelis who happened to be a former CMS staffer who had written a key federal rule on electronic payments.
Zelis and other payment processors say they offer value in return for their fees: Doctors can sign up to receive reimbursements from hundreds of insurers through a single payment processor, and they can get services that help match up electronic payments and receipts. Zelis asserted in a statement that its services remove “many of the obstacles that keep providers from efficiently initiating, receiving, and benefitting from electronic payments.” While Zelis and other companies insist that it is easy to opt out of their services, doctors say otherwise.
Staffing Agencies Drive Up Costs For Health Facilities
Steve Ahnen, president of the New Hampshire Hospital Association, said the staffing shortages at hospitals, nursing homes, and other medical facilities are unsustainable. The New Hampshire Bulletin focused on the Hillsborough County Nursing Home, which has 120 people on the waiting list, but the problem is the same across the state. Facilities are unable to offer high enough wages to recruit the nurses and aides they need, forcing them to rely on staffing agencies, which charge more than double the hourly rate to put temporary workers in those positions, typically for 13-week periods. Even then, the facilities are unable to fill all the openings. Hillsborough County has had to close 50 of the nursing home’s 300 beds.
Senate Bill 149, signed last week, establishes a licensing and application process for nurse agencies that limits costs without a formal wage cap. Beginning in October, staffing agencies will be prohibited from double-booking a nurse or aide which has allowed agencies to pressure medical facilities into bidding wars. They no longer will be able to use the excuse of there being a communicable virus to justify increasing their fees. While many nursing contracts already prevent agencies from recruiting staff from the facilities that have hired them, the new law specifically disallows that practice.
The law also forbids agencies from placing nurses or aides whose professional licenses have been suspended. As of January 1, the staffing agencies also will have to register with the state Office of Professional Licensure and Certification in order to maintain their licenses to operate.
One provision that was stripped from the bill before passage was a proposed requirement that would have forced staffing agencies to reveal publicly how much they are charging the health facilities and how much of that fee they are paying their workers. That information would give administrators a better sense of how much they would have to increase their wages to be competitive. Both the New Hampshire Department of Health and Human Services and the staffing agencies argued that it would be overly burdensome and costly to comply with the requirement.
Pennsylvania Hiker Dies In White Mountains
A Pennsylvania man died after experiencing an unknown medical problem while ascending the Osgood Trail, which leads to Mount Madison, on August 11. Jason Apreku, 21, of Stroudsburg, Pennsylvania, was hiking with friends when he collapsed on the trail. His friend called 911 and attempted cardiopulmonary resuscitation until personnel from the Appalachian Mountain Club and passing hikers arrived to assist in the life-saving effort.
New Hampshire Fish and Game Officers, the New Hampshire Army National Guard, and the Androscoggin Valley Search and Rescue Team responded to the 911 call. National Guard helicopter crews responded from Concord despite wind gusts as high as 90 miles per hour, with a wind chill of 29 degrees, on nearby Mount Washington. The helicopter crew flew to the highest elevations that the cloud cover would allow in order to assess the chance of getting Apreku off the mountain and determined it could not get to the hiker. An alternate attempt to fly two conservation officers to the mountain ridge was scrapped when the severe wind made the risk of dropping the conservation officers below tree line too risky.
Rescue crews continued on foot throughout the night and into the morning of August 12, placing Apreku in a litter and carrying him to Madison Spring Hut, arriving at 4:10 a.m. A second wave of conservation officers hiked from the Appalachia Parking Lot to relieve the AVSAR team. They again asked for a helicopter crew at 7 a.m., and the crew was able fly to the Madison Spring Hut and bring Apreku off the mountain. The National Guard made two more trips to the hut to relay the rescue personnel.
Apreku was placed in the care of Bryant’s Funeral Home in Berlin.
Trump Faces Mandatory Five-Year Sentence In Georgia
A Georgia grand jury has handed up the fourth indictment Donald Trump faces for his efforts to overturn the 2020 election results, this time bringing RICO (Racketeer Influenced and Corrupt Organization) charges that carry a mandatory five-year prison sentence. The 41-count indictment includes solicitation of a violation of an oath by a public officer (his infamous call with Georgia Republican Secretary of State Brad Raffensperger in which Trump pushed him to “find” the necessary votes to reverse Trump’s loss in the state).
Also charged were Trump lawyers Rudy Giuliani, John Eastman, Kenneth Cheseboro, Jenna Ellis, and Sidney Powell; former White House chief of staff Mark Meadows; former Department of Justice official Jeffrey Clark; and a number of so-called fake electors who signed certificates saying Trump won Georgia and purporting to be official electors. Among them is former Georgia Republican Party Chair David Shafer.
Georgia's RICO law allows prosecutors to pursue charges against members of an “enterprise” that shows a “pattern of racketeering activity” through “predicate acts” demonstrating persistent efforts involving many figures. The indictment lists 161 predicate acts, covering a range of actions inside Georgia and across the country. The state RICO Act is broader than the federal RICO law and also means that, even if Trump avoids federal charges or receives a federal pardon, he can be held accountable under Georgia’s law. A pardon for the state-level crimes would have to go through the independent Georgia Board of Pardons and Paroles but could not come before any sentences are served.
An indictment is not a finding of guilt, but an independent jury’s decision, after hearing from prosecutors, that sufficient evidence exists to warrant a court trial.
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