Texas Judge rules against NSA

[bravotwozero]

Long live the republic of Texas!

Federal judge rules against HHS - again - over surprise billing arbitration rule

A federal judge in Texas has handed another win to the Texas Medical Association and medical providers nationwide against HHS over a challenge to the arbitration process between out-of-network providers and payers that was established under the No Surprises Act.

On Feb. 6, U.S. District Judge Jeremy Kernodle ruled that the revised arbitration process "continues to place a thumb on the scale" in favor of insurers and "that the challenged portions of the final rule are unlawful and must be set aside…"

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[RustedFox]

Can we just not have a fair billing system?

 

[HemeOncHopeful19]

Can we just not have a fair billing system?

Can we go back to the 80s-90s when all the MDs were paid like today’s Orthobros and somehow it was all cheaper anyway

 

[emergentmd]

Insurance is overly complicated thus making it easy for the industry to create their own rules. They have an abundance of money so can write the laws or interpret the laws to their favor. Nothing will change. Even laws that is patient/practitioner biased will be executed to the carriers favor. Nothing will change.

 

[bravotwozero]

Perhaps, but they've been stalled for now. Plus, with a divided house and senate, congressional gridlock will slow things down further.

 

[Brigade4Radiant]

Insurance is really powerful in the US they can practice medicine have direct payments and have no liability. They can deny cancer screenings and services but they won’t be sued.

 

[southerndoc]

This is a step in the right direction. I believe there is more to come... stay tuned.

 

[EctopicFetus]

Can we go back to the 80s-90s when all the MDs were paid like today’s Orthobros and somehow it was all cheaper anyway

Fewer noctors and all these *****ic uneducated managers of diseases. No stroke coordinator, chest pain coordinator, trauma coordinator fewer managers whose only job is to go to meetings ask dumb questions and create work for those who actually do work.

 

[EctopicFetus]

Keep in mind for those who think this doesn’t matter. While congress imo is bought and paid for by special interests the courts can act without their input. These wins vs the interpretation of the nsa are indeed a big deal.

 

[Janders]

Yes, this is a big deal.

Even accepting congress is imperfect and the NSA is imperfect, it did contain protections and wording to at least give physicians a chance for reasonably even playing field; the implementation rules have been OBVIOUSLY slanted incredibly in favor of insurance, to the point that bipartisan legislators have repeatedly called it out. And amazingly the courts have agreed. Which tells you HOW slanted it was...

 

[Fpg1245]

Yes, this is a big deal.

Even accepting congress is imperfect and the NSA is imperfect, it did contain protections and wording to at least give physicians a chance for reasonably even playing field; the implementation rules have been OBVIOUSLY slanted incredibly in favor of insurance, to the point that bipartisan legislators have repeatedly called it out. And amazingly the courts have agreed. Which tells you HOW slanted it was...

The fact that it was passed in that form also tells you just how slanted congress really is

 

[EctopicFetus]

The fact that it was passed in that form also tells you just how slanted congress really is

The actual law is fairly neutral the rule making process is what is slanted and screwed docs.

 

[Dred Pirate]

Fewer noctors and all these *****ic uneducated managers of diseases. No stroke coordinator, chest pain coordinator, trauma coordinator fewer managers whose only job is to go to meetings ask dumb questions and create work for those who actually do work.

off topic, but I had to share this story- code stroke comes in - the stroke coordinator tells me they are not a TPA candidate (benefits of TPA are a completely different discussion) because they are on an anti-coagulant. I tell her that I don't see it on their chart. She says "right here plavix". I told her that is not an anticoagulant and not a contraindication, she didn't believe without some significant debate. I was dumbfounded. I mean I could sorta of see that from a floor med-surg RN that doesn't deal with those meds much, but not a stroke coordinator who has been in the position for at least 5 years. To many middle mgmt people/positions is such a waste of resources.

 

[RustedFox]

off topic, but I had to share this story- code stroke comes in - the stroke coordinator tells me they are not a TPA candidate (benefits of TPA are a completely different discussion) because they are on an anti-coagulant. I tell her that I don't see it on their chart. She says "right here plavix". I told her that is not an anticoagulant and not a contraindication, she didn't believe without some significant debate. I was dumbfounded. I mean I could sorta of see that from a floor med-surg RN that doesn't deal with those meds much, but not a stroke coordinator who has been in the position for at least 5 years. To many middle mgmt people/positions is such a waste of resources.

This is one of my pet peeves in healthcare. Hear me out; I can be an arrogant ass at times.

(Hypothetical PSA speech: )

Are you a nurse? Paramedic? NP? Good. Are you a healthcare *professional*? Good.

Can you SOUND like one? You know, use your grown-up words? Stop calling everything a "thinner". You can discern what is an anti-PLATELET drug and what is an anti-COAGULANT drug. Learn them. Do that.

 

[turkeyjerky]

This is one of my pet peeves in healthcare. Hear me out; I can be an arrogant ass at times.

(Hypothetical PSA speech: )

Are you a nurse? Paramedic? NP? Good. Are you a healthcare *professional*? Good.

Can you SOUND like one? You know, use your grown-up words? Stop calling everything a "thinner". You can discern what is an anti-PLATELET drug and what is an anti-COAGULANT drug. Learn them. Do that.

This is something I've noticed over the past few months too. Is there some new nursing education thing or something? It seems to correspond w/ the rampant overusage of "trauma" alerts. Typical scenario--old person walks up to triage after driving themselves to the ER following a minimal head injury. "Trauma alert Bed 2" paged overhead. !Doc! She's on ***thinners***! (aspirin).

Naturally, in that case, I'll order 2 trauma pan-scans.

 

[WilcoWorld]

Insurance is overly complicated thus making it easy for the industry to create their own rules. They have an abundance of money so can write the laws or interpret the laws to their favor. Nothing will change. Even laws that is patient/practitioner biased will be executed to the carriers favor. Nothing will change.

I agree with your first two sentences. However "nothing will change" is a self-fulfilling prophecy. I reject it.

 

[Tiger26]

Can we go back to the 80s-90s when all the MDs were paid like today’s Orthobros and somehow it was all cheaper anyway

When there were more doctors than administrators? Must've been paradise

 

[EctopicFetus]

I placate these clowns but make it as politely painful as possible. Recently we got cited by the jc over lack of nitro use for mis. I said gosh that’s crazy please provide me the references that show a mortality benefit and where in the literature we give this. Also should we give this to all STEMIs? Non stemis? Inferior mis? People taking viagra (i know).

have them pull the references.
had a similar thing with cardiology that made up some bs rule from the aha about how soon we need to “sign” the EKGs. We use a separate system and review all EKGs within 5 mins. I said sure man. Just find the citation for me so we can make sure we follow it. Shortly after 🦗

usually being direct with these clowns can result in you being labeled as difficult. But give them some tasks and oddly it goes away. Their knowledge is very superficial. Their understanding is usually not even superficial.

 

[southerndoc]

off topic, but I had to share this story- code stroke comes in - the stroke coordinator tells me they are not a TPA candidate (benefits of TPA are a completely different discussion) because they are on an anti-coagulant. I tell her that I don't see it on their chart. She says "right here plavix". I told her that is not an anticoagulant and not a contraindication, she didn't believe without some significant debate. I was dumbfounded. I mean I could sorta of see that from a floor med-surg RN that doesn't deal with those meds much, but not a stroke coordinator who has been in the position for at least 5 years. To many middle mgmt people/positions is such a waste of resources.

She's probably thinking ASA + clopidogrel. The two together have like a 12-13% bleed rate with thrombolysis. Still doesn't count as a contraindication. Clopidogrel alone does not raise your risk that significantly.

 

[Dred Pirate]

She's probably thinking ASA + clopidogrel. The two together have like a 12-13% bleed rate with thrombolysis. Still doesn't count as a contraindication. Clopidogrel alone does not raise your risk that significantly

no- she straight up thought it was an anti-coagulant - later she came back and apologized and said she "didn't know the new aspirin-like drugs"

it is painful

 

[HemeOncHopeful19]

no- she straight up thought it was an anti-coagulant - later she came back and apologized and said she "didn't know the new aspirin-like drugs"

it is painful

Even funnier to me because you’re a pharmacist. Like who really argues with a pharmacist about drugs?

I mean sure if it’s a drug specific to your specialty (Anesthesia, EM, Heme Onc, etc.) then a doctor might be more familiar than the random inpatient/outpatient pharmacist who rarely deals with them… but a nurse stroke coordinator? SMH

(PS even if I think I know better if a pharmacist ever questions me I always go back and triple check whatever they’re asking about)

 

[Fpg1245]

no- she straight up thought it was an anti-coagulant - later she came back and apologized and said she "didn't know the new aspirin-like drugs"

it is painful

Even funnier because they aren’t new at this point.

 

[Dred Pirate]

Even funnier to me because you’re a pharmacist. Like who really argues with a pharmacist about drugs?

I mean sure if it’s a drug specific to your specialty (Anesthesia, EM, Heme Onc, etc.) then a doctor might be more familiar than the random inpatient/outpatient pharmacist who rarely deals with them… but a nurse stroke coordinator? SMH

(PS even if I think I know better if a pharmacist ever questions me I always go back and triple check whatever they’re asking about)

I appreciate that - I mean I don't tell an ID doc they ordered the wrong abx, or a oncologist they have the wrong chemo, or a surgeon- oh wait, they don't know drugs (I kid)

 

[HemorrhagicShock]

I appreciate that - I mean I don't tell an ID doc they ordered the wrong abx, or a oncologist they have the wrong chemo, or a surgeon- oh wait, they don't know drugs (I kid)

What are you talking about? The surgeons definitely know a wide variety of pharmacological options:
- Dilaudid 1mg IV Q4H PRN pain
- Norco 1 tab PO Q6H PRN post-op pain dispense 60, 2 refills
- Oxycodone 1mg/ml take 10ml PO Q4H PRN breakthrough pain not controlled by Norco

 

[WilcoWorld]

no- she straight up thought it was an anti-coagulant - later she came back and apologized and said she "didn't know the new aspirin-like drugs"

it is painful

I mean, it's only been approved since 1997.

 

[HemeOncHopeful19]

What are you talking about? The surgeons definitely know a wide variety of pharmacological options:
- Dilaudid 1mg IV Q4H PRN pain
- Norco 1 tab PO Q6H PRN post-op pain dispense 60, 2 refills
- Oxycodone 1mg/ml take 10ml PO Q4H PRN breakthrough pain not controlled by Norco

You forgot

-Multimodal pain control