U.S. Opens UnitedHealth Antitrust Probe

The Wall Street Journal | By Anna Wilde Mathews and Dave Michaels

The Justice Department has launched an antitrust investigation into UnitedHealth, owner of the biggest U.S. health insurer, a leading manager of drug benefits and a sprawling network of doctor groups.

The investigators have in recent weeks been interviewing healthcare-industry representatives in sectors where UnitedHealth competes, including doctor groups, according to people with knowledge of the meetings.

During their interviews, investigators have asked about issues including certain relationships between the company’s UnitedHealthcare insurance unit and its Optum health-services arm, which owns physician groups, among other assets. 

Investigators have asked about the possible effects of the company’s doctor-group acquisitions on rivals and consumers, the people said…

…The new Justice Department inquiry, reported earlier by the Examiner News, a news organization based in New York’s Hudson Valley, is partly examining Optum’s acquisitions of doctor groups and how the ownership of physician and health-plan units affects competition, according to the people with knowledge of the matter.

Investigators have asked whether UnitedHealthcare favored Optum-owned groups in its contracting practices, potentially squeezing rival physicians out of certain types of attractive payment arrangements.  

Investigators have also explored whether Optum’s ownership of healthcare providers could present challenges to health insurers that are rivals to UnitedHealthcare.

In addition, the Justice Department officials are investigating Medicare billing issues, including the company’s practices around documenting patients’ illnesses. 

Payments to Medicare plans go up if patients have more health conditions, so aggressive documentation practices by doctors and other healthcare providers can be lucrative for insurers such as UnitedHealthcare.

And investigators have asked whether and how the tie-up between UnitedHealthcare and Optum medical groups might affect its compliance with federal rules that cap how much a health-insurance company retains from the premiums it collects from customers…

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Communicating Bad News to Patients

Medscape Medical News | By Paolo Spriano

Communicating bad news to patients is one of the most stressful and challenging clinical tasks for any physician, regardless of his or her specialty. Delivering bad news to a patient or their close relative is demanding because the information provided during the dialogue can substantially alter the person's perspective on life. This task is more frequent for physicians caring for oncology patients and can also affect the physician's emotional state.

The manner in which bad news is communicated plays a significant role in the psychological burden on the patient, and various communication techniques and guidelines have been developed to enable physicians to perform this difficult task effectively.

Revealing bad news in person whenever possible, to address the emotional responses of patients or relatives, is part of the prevailing expert recommendations. However, it has been acknowledged that in certain situations, communicating bad news over the phone is more feasible.

Since the beginning of the COVID-19 pandemic, the disclosure of bad news over the phone has become a necessary substitute for in-person visits and an integral part of clinical practice worldwide. It remains to be clarified what the real psychological impact on patients and their closest relatives is when delivering bad news over the phone compared with delivering it in person.

Right and Wrong Ways

The most popular guideline for communicating bad news is SPIKES, a six-phase protocol with a special application for cancer patients. It is used in various countries (eg, the United States, France, and Germany) as a guide for this sensitive practice and for training in communication skills in this context…

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Reduced Federal Share May Force State Medicaid Programs to Cut Services, HCBS Expert Says

McKnight’s Home Care | By Adam Healy

Though a recent period of Medicaid “unwinding” has slashed the number of enrollees, federal actions have continued to put pressure on states and could result in program cuts in the coming years, one home- and community-based services expert said. 

The Congressional Budget Office this month released its “Budget and Economic Outlook” report for the coming decade. In its report, CBO predicted a roughly $58 billion drop in federal Medicaid outlays for 2024 compared to 2023 — a 9% decrease in federal Medicaid spending, due in part to fewer beneficiaries on states’ Medicaid rolls. 

Reduced Medicaid outlays, in addition to the phasing out of the Federal Medical Assistance Percentage (FMAP), which provided enhanced federal Medicaid funding for states during the pandemic, has placed an even greater strain on states to pay for these Medicaid programs, according to Damon Terzaghi, director of Medicaid HCBS for the National Association for Home Care & Hospice.

“The reduction in the federal outlays is essentially going to result in one of two things — increased state spending to offset the reduced federal share, or a cut to Medicaid [services or staff] to make up the difference,” he told McKnight’s Home Care Daily Pulse. “I think it will likely end up being a combination of the two.”

State budgets this year will likely focus more on maintaining current spending levels, rather than increasing them, Terzaghi said. And the states that are unable to manage the increased burden may have to cut Medicaid staff or services. Perhaps as one example, New York, Gov. Kathy Hochul (D) floated $1.2 billion worth of Medicaid cuts in a recent budget proposal, including a $400 million reduction for long-term care services and a $200 million cut to the state’s consumer-directed personal assistance program.

“There are obviously a lot of dynamics at play so we can’t solely blame the expiration of the … FMAP bump for any of these proposals,” Terzaghi said. “I certainly don’t think it will give states more money to play with though.”

In recent months, the so-called Medicaid unwinding, a result of states redetermining beneficiaries’ eligibility following a period of continuous enrollment during the COVID-19 pandemic, has resulted in more than 16 million Medicaid terminations — or about 17% of overall enrollment, according to KFF. States still have more than 45 million enrollees to reassess, and the number of terminations is expected to continue growing.

Nurses for Medically Fragile Kids are Underpaid and Hard to Find. Parents Want the State to Step In.

The Colorado Sun | By Jennifer Brown

Nurses willing to care for medically fragile children and adults — including patients who use feeding tubes, can’t walk or speak, and rarely leave their homes — are hard to find in Colorado. 

Amid a statewide nursing shortage so dire that even state mental institutions offer $14,000 signing bonuses, the lowest-paying nursing positions are going unfilled. That means many parents who have relied on “private duty nurses” for in-home care for their children and adult children are getting no help. 

Colorado’s Medicaid program reimburses the agencies that employ these in-home nurses at some of the lowest rates in the nation, according to the Home Care and Hospice Association of Colorado. The rate for registered nurses in Colorado is $7.05 per hour below the national median, while the rate for licensed practical nurses is $9.04 below the median, according to the association’s analysis. 

This puts Colorado in the bottom third of states and it’s why parents of children with extreme health issues are asking lawmakers for a $15 million boost in state funding. The money would raise Medicaid rates that pay nurses’ salaries...

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