Phia Group

Is the Department of Labor Offsetting a Major Problem?

On January 3, 2024
As if Americans on employer-based health plans didn’t face enough obstacles in trying to obtain reasonably priced healthcare.

For Sickle Cell Disease Patients, Hope Has Arrived – but at What Cost?

On December 21, 2023
For generations of sickle cell disease (SCD) patients, the suffering has been unbearable – with no end in sight. SCD, an inherited genetic red blood cell disorder that affects hemoglobin, the protein that carries oxygen throughout the body, torments nearly 100,000 Americans (20 million people worldwide), a disproportionate number of whom are African-American. Among other symptoms, SCD often triggers chronic bouts of excruciating pain that require regular hospitalization, organ failure, strokes, and shortened life expectancy. Meanwhile, the only known cure for the insidious disease has been a bone marrow transplant.

Benefest 2023: Talking Costs and Laws with Carriers

On July 31, 2023
By March, amidst the snowbanks contracting and days growing incrementally longer, conference season – at least for the healthcare industry -- is in full bloom. One of the marquee Massachusetts-based healthcare conferences, Benefest 2023, focused on “shaping the future of healthcare” in the commonwealth, was held earlier this summer at Worcester’s Polar Park -- during the peak of conference season.

IDR Entities Still Struggling with Volume – Highlights from the Q4 2022 Report

On July 17, 2023
Under the No Surprises Act (NSA), the Departments of Health and Human Services, Labor, and Treasury are required to post quarterly data on the Federal Independent Dispute Resolution (IDR) process. In response to the federal court decision in Texas Medical Association, et al. v. United States Department of Health and Human Services, portions of the governing regulations were vacated, resulting in a February 10, 2023 order for IDR entities to cease issuing new payment determinations (see https://www.cms.gov/nosurprises/help-resolve-payment-disputes/payment-disputes-between-providers-and-health-plans). This was lifted as of February 24, 2023 for services furnished before October 25, 2022, and as of March 17, 2023 for services furnished on or after October 25, 2022. Because there was essentially a freeze on IDR proceedings for a good portion of Quarter 1 of 2023, the report issued for Quarter 4 of 2022, available at https://www.cms.gov/files/document/partial-report-idr-process-octoberdecember-2022.pdf, is the most recent and complete picture we have of how the process is performing.

Hospital Prices: Fully Transparent or Still Somewhat Opaque?

On February 23, 2023
In the throes of the first pandemic winter, still months before coronavirus vaccines would roll out in earnest, the Hospital Price Transparency Rule went into effect. It was a promising development in the world of healthcare cost containment—hospitals were now obligated to provide a single, machine-readable digital file containing standard charges for all services and items provided by the facility.