Health

Tennessee's Process for Handling Disability Applications Stirs Controversy

The way Tennessee physicians earn money by reviewing disability claims is stirring controversy, The Tennessean reports. There are currently about 50 doctors statewide who review disability applications, for which they receive a flat rate payment on each claim filed. Detractors feel that this incentivizes the physicians to speed through the review process because how much they earn depends on how fast they work. The article notes one doctor in particular who earned $420,000 for reviewing the disability applications of 9,088 Tennesseans during the 2018 fiscal year, averaging 12 minutes on each case. 80 percent of the cases reviewed by this doctor were denied. Tennessee has among the highest denial rates for disability applicants, rejecting 72 percent of all claims in 2017 compared to the national average of 66 percent.

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House Files Motion to Intervene in Texas ACA Case

The U.S. House of Representatives recently filed a motion in federal court requesting intervention in the Texas court case that found the Affordable Care Act (ACA) unconstitutional, CNBC reports. U.S. District Court Judge Reed O'Connor last month ruled that the law was unconstitutional after the 2017 Tax Act eliminated penalties for adults without health insurance. A lawyer for the House said in the filing that federal legal rules give “the House an unconditional right to intervene,” given the ACA was passed into law by Congress and that the Trump administration is not defending the law, maintaining that “interest in this action ... is not adequately represented by the existing parties.” O’Connor has stayed his ruling pending appeal.

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New Tennessee Abortion Law Will Not Require Patients to View or Listen to Ultrasounds

The Tennessee law enacted this year regarding ultrasounds prior to abortions will not mandate that the patient view or listen to the ultrasound, but instead requires the physician to include a new disposition in the report indicating whether a heartbeat was detected and to provide the woman an opportunity to learn the results if requested, NPR reports. The bill began as a ban on abortions after the detection of a heartbeat, however, was amended because of the U.S. Supreme Court's recent decision to strike down abortion restrictions in Texas out of concern that the court would find Tennessee’s restrictions similarly unconstitutional. Bill sponsor Rep. Micah VanHuss (R-Jonesborough) told his colleagues that he still thought it would lead to fewer abortions, but Rep. John Ray Clemmons (D-Nashville) questioned whether the new rules disregard the anguish of a woman considering abortion.

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AG Slatery Defends Participation in ACA Lawsuit

Tennessee Attorney General Herbert Slatery is defending his participation in the lawsuit that led to a federal judge to rule the Affordable Care Act (ACA) as unconstitutional, saying “the Commerce Clause of our Constitution that, according to the court, prevents Congress from compelling Tennesseans to buy insurance, especially if they can't afford it or don't want it,” The Chattanooga Times Free Press reports. U.S. District Court Judge Reed O'Connor last December ruled in favor of the 19 Republican state attorneys general, who argued that the law was unconstitutional after the 2017 Tax Act eliminated penalties for adults without health insurance. The U.S. Supreme Court had previously upheld the mandate, saying it was constitutional because it fell under Congress's taxing power. State Democrats have blasted the ruling, warning of consequences for the 1.7 million Tennesseans with pre-existing health conditions and the quarter of a million people in the state who obtain their insurance coverage through the ACA.

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Rural Clinics Grapple with Frozen TennCare Payments

An estimated 20 rural health clinics that opened in the last 15 months are facing financial distress due to promised TennCare payments being temporarily frozen until the state establishes new payment rules, The Tennessean reports. Many of these clinics are the only health provider in the area due to several rural hospital closures. While national and state health care organizations have expressed the necessity of ending the moratorium, a TennCare spokeswoman defended the freeze due to the complicated nature of creating required rules for billing procedures for all of the state’s 150 rural clinics.  The moratorium has been extended twice; the current freeze is scheduled to end in April but could be extended again.  

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Lauderdale Hospital Struggling with Financial Hardships

Employees at Lauderdale Community Hospital in Ripley did not receive a paycheck for two weeks, WREG reports. The hospital is operated by Kansas City-based EmpowerHMS, which also missed payroll for several of its hospitals in Oklahoma as well. The employees were eventually paid on Friday; however, the hospital is still facing financial hardships, owing the city of Ripley $186,709.00 in back taxes and Lauderdale County $164,985.50 in back taxes. Hospital CEO Michael Layfield said that the facility is facing the same financial woes as many other rural hospitals and that the organization is “struggling because of volumes dropping and decreases in reimbursement."

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State Democrats Ask AG Slatery to Remove Tennessee from ACA Lawsuit

Tennessee Democrats rebuked a federal judge's ruling that the ACA is unconstitutional and are asking Tennessee Attorney General Herbert Slatery to remove Tennessee from the lawsuit, The Chattanooga Times Free Press reports. U.S. District Court Judge Reed O'Connor on Friday ruled that because a 2017 congressional tax bill eliminated penalties for those without health insurance, the ACA is unconstitutional. The lawmakers are calling on Senator Lamar Alexander, who is chairman of the Senate Health Committee, to protect Tennesseans — of which 1.26 million have preexisting health conditions — should the ruling be upheld on appeal. Alexander previously supported a "repeal and replace" plan, saying, "I don't think Tennesseans would be comfortable canceling insurance for 22 million Americans and trusting Congress to find a replacement in two years.”

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Department of Health Requests More Information on Ballad NICU Consolidation

The Tennessee Department of Health has requested additional information regarding Ballad Health's plans to consolidate NICU services in the tri-cities area, WJHL reports. Currently, two area hospitals — Holston Valley Medical Center (HVMC) in Kingsport and Johnson City Medical Center — have Level III NICUs, however, Ballad’s plan would reduce HVMC to a Level I nursery. Some of the information requested by the department includes how the hospitals will handle high-risk pregnancies in a non-NICU facility, financial analysis for the project and estimated timeline for completion.

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Bright Health Raises $200 Million to Finance Ongoing Expansion

Bright Health announced Thursday that it has raised another $200 million to support ongoing expansion, which includes entering the Tennessee individual health insurance market. It will offer plans in three metro areas, The Star Tribune reports. The company sells insurance focused on one health care system in a community, with the goal of letting the network of doctors and hospitals coordinate services and cutting consumer costs. The Minneapolis-based insurer said it has raised more than $440 million in three rounds of equity financing since 2016.

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CVS to Scale Back Retail Operations After Aetna Acquisition

Pharmacy chain CVS Health on Wednesday announced that it plans to reduce the amount of store space devoted to retail and shift more to health care after its acquisition of Aetna, USA Today reports. With the $70 billion-dollar deal, CVS intends to position itself to control key health care components such as pharmacy, drug distribution and insurance. The acquisition has not been without controversy, with U.S. District Judge Richard Leon admonishing a U.S. Justice Department lawyer on Thursday for keeping him “in the dark” and treating his antitrust review as a “rubber stamp operation.” The Justice Department approved the deal in October on the condition that Aetna sells its Medicare Part D prescription drug plan business.

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