Among the proposed changes: State exchanges would have to establish open enrollment periods that mirror the sign-up period on federal exchanges, from Nov. 1 to at least Jan. 15.
Modern Healthcare:
2025 Benefit And Payment Parameters Proposed Rule Issued
State-run health insurance exchanges would have to ensure that provider networks are at least as adequate as those required on the federal marketplaces under a proposed rule the Centers for Medicare and Medicaid Services announced Wednesday. Beginning in 2025, insurance policies sold through full-featured state-based exchanges and through state-operated marketplaces that use the federal HealthCare.gov enrollment platform would have to meet the time-and-distance measure of provider access that is applied to plans sold via fully federal exchanges. States can seek exemptions. (Young, 11/15)
Modern Healthcare:
Home Health Providers Seek Workplace Violence Solutions
A trade group representing the home health industry is developing recommendations on how home health agencies can protect employees from dangerous situations as more care moves into the home. The National Association for Home Care and Hospice convened a task force in January to address growing concerns over workplace violence. It is recommending training for staff by law enforcement officers, sending security escorts with nurses into homes and, when necessary, doubling the number of nurses making in-home visits. (Eastabrook, 11/15)
KFF Health News:
Compensation Is Key To Fixing Primary Care Shortage
Money talks. The United States faces a serious shortage of primary care physicians for many reasons, but one, in particular, is inescapable: compensation. Substantial disparities between what primary care physicians earn relative to specialists like orthopedists and cardiologists can weigh into medical students’ decisions about which field to choose. Plus, the system that Medicare and other health plans use to pay doctors generally places more value on doing procedures like replacing a knee or inserting a stent than on delivering the whole-person, long-term health care management that primary care physicians provide. (Andrews, 11/16)
Reuters:
Two Former NBA Players Are Convicted Over Roles In Health Care Fraud
A federal jury in Manhattan on Wednesday convicted two former National Basketball Association players over their roles in a scheme to defraud a league healthcare plan into paying millions of dollars for bogus medical procedures. Glen Davis, 37, who played for three NBA teams and won a championship in 2008 with the Boston Celtics, was convicted on four counts including wire fraud, health care fraud, conspiring to commit fraud, and conspiring to make false statements. Will Bynum, 40, who played for three teams including the Detroit Pistons, was found guilty of conspiring to make false statements, but acquitted on a fraud conspiracy charge. … Examples of the alleged fraudulent medical procedures included Davis and another player receiving crowns on the same six teeth on the same day, and Davis receiving crowns on eight teeth in Beverly Hills though he was in Nevada. (Stempel, 11/15)
On artificial intelligence —
Axios:
Elsevier Partners With Startup To Give Doctors AI Access To Research
Scientific information and data analytics giant Elsevier is partnering with a medical startup to give doctors the ability to use generative AI to access the most up-to-date medical research as they treat patients in real time. Experts say the adoption of AI could dramatically improve the quality of care patients receive — while also lowering costs, cutting wait times and expanding access. (Fried, 11/15)
The Boston Globe:
Doctors Find AI Text-To-Image Generators Perpetuate Societal Biases
Dr. Rohaid Ali, a neurosurgery resident at Brown University … grew concerned about patterns of racial and gender bias among the AI tools and decided to investigate how unrepresentative they are. Their study, which was published Wednesday in the journal JAMA Surgery, found that two of the systems depicted 98 percent of surgeons as white males — not representative of the industry’s increasingly diverse makeup. … “It’s really a slap in the face to the surgeons who are women and people of color.” (Scales, 11/15)
Modern Healthcare:
Softbank-Backed Forward Gets $100M For AI-Powered CarePods
Forward, a tech-enabled, subscription-based care company, raised $100 million in funding to manufacture and deploy self-service healthcare pods. Forward said the pods, called CarePods, will use AI, telehealth and biometric sensors to serve patients with diabetes, hypertension, anxiety and depression. The company plans to place CarePods in malls, gyms and offices. (Turner, 11/15)
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