With all of the controversy coming out of Washington and Sacramento, it is easy to miss the latest news going on in our industry. Therefore, being a member of NCEBC has many benefits. We offer great networking and social events to relax with colleagues, educational sessions with industry leaders, our annual golf tournament and a monthly newsletter. If you are a member, let co-workers and clients know why you find membership valuable and point them to our website. As always, we want to thank our members for their participation in our chapter!
23rd NCEBC Golf Tourney - Harding Park
August 14, 2017
10:00 AM to 5:00 PM
Returning to the Gorgeous Harding Park Course - Sponsorships Opportunities Still Available
NCEBC Holiday Party
November 16, 2017
4:00 PM to 7:00 PM
Embarcadero Center, 4 Embarcadero Center, Lobby Level
San Francisco, CA 94111
Always an Industry Favorite
Cruz's Prescription to save Healthcare
Sen. Ted Cruz of Texas has a plan to save the GOP's once again moribund repeal of Obamacare. All it requires is a bunch of senators agreeing to tell sicker Americans who are looking for insurance coverage to go pound sand.
Senate Majority Leader Mitch McConnell, R-Ky., is still casting about in an attempt to scrounge up at least 50 votes for his Better Care Reconciliation Act, the upper chamber's repeal of the Affordable Care Act, aka Obamacare. Thus far, he has been unsuccessful in corralling both the more conservative wing of his caucus – made up of the likes of Cruz and Sens. Mike Lee, R-Utah, and Rand Paul, R-Ky. – and the so-called moderates, who have gotten queasy about the more than 20 million people the bill would leave uninsured compared to current law, as well as the ditching of Obamacare's protections for those who have pre-existing medical conditions.
One side wants deeper and uglier spending cuts and for more of Obamacare's regulatory structure to be dismantled, and the other wants to come up with something that won't generate visions of the Red Wedding when it's scored by the Congressional Budget Office, Congress' nonpartisan assessor of all things legislative. That's a hard circle to square.
Thus, into the breach stepped Cruz.
Per Cruz's plan, known as the Consumer Freedom Act, so long as insurers offer one plan in a state that is compliant with current Obamacare levels of required benefits, including protections for those with pre-existing conditions, then that insurer can also offer other plans that don't meet the minimum benefit requirements. In theory, this is meant to allow GOP senators who want to claim that they kept Obamacare's protections in place to do so, while at the same time allowing other senators to claim that they've undone that law's regulatory regime.
But that's just the theory. In practice, Cruz's plan would create a bifurcated health insurance system, with sicker Americans having to buy into the plans with more protections, while healthier, presumably younger, people opt for the thinner plans.
For folks in the former group, the sicker pool of applicants would inevitably result in higher premiums, eventually forcing out any healthy people who stumbled in, driving up prices even more and setting up the sort of insurance market death spiral that Republicans always like to complain about.
Cruz claims that government subsidies would fill the void, bringing down costs for those in the still-Obamacare-regulated plans. But plenty of people who don't qualify for those subsidies would be dinged too, and it's unclear that anyone has the appetite to keep increasing subsidies for a set of insurance plans that is going to keep getting more and more expensive.
It's a lot of downside, with little up. It has the feel of Cruz throwing something at the wall to see if it sticks, rather than a well-thought-out proposal that would fix what currently ails the health insurance market.
And yet some GOP senators are totally on board, as is the White House. Lee has even said that his vote is contingent on the adoption of Cruz's amendment. McConnell can only lose two votes from the GOP's 52-person caucus, so any potential defector is a huge problem. Plenty of other senators, though, aren't sold on Cruz's idea.
eClinicalWorks to pay $155 million to settle suit alleging it faked meaningful use certification
U.S. Attorney says that the resolution proves EHR vendors can’t ‘flout’ certification requirements and get away with it.
Electronic health records vendor eClinicalWorks has agreed to pay $155 million to resolve a False Claims Act lawsuit that alleged it gave customers kickbacks for publicly promoting its products.
“This resolution demonstrates that EHR companies will not succeed in flouting the certification requirements,” said Acting U.S. Attorney for the District of Vermont Eugenia Cowles.
Cowles was referring to the requirements EHR vendors must meet under the American Recovery and Reinvestment Act’s HITECH Act that their software satisfies criteria by an accredited testing body so that customers can use it to attest for EHR reimbursement under the meaningful use program.
“The government contends that ECW falsely obtained that certification for its EHR software when it concealed from its certifying entity that its software did not comply with the requirements for certification,” the DOJ statement said.
The DOJ alleges that eClinicalWorks opted to added the 16 drug codes necessary for certification into its software rather than enable the product to access those from a complete database, failed to accurately record user actions with audit log functionality, did not always accurately record diagnostic imaging orders or conduct drug-drug interaction checks and, finally, eClinicalWorks did not satisfy data portability requirements designed to enable doctors to transfer patient data to over vendor’s EHRs.
“As a result of these and other deficiencies in its software, ECW caused the submission of false claims for federal incentive payments based on the use of ECW’s software,” the Vermont DOJ said.
eClinicalWorks disputed the allegations that its customer program was unlawful but said it settled to avoid the expense of litigation.
“Today’s settlement recognizes that we have addressed the issues raised, and have taken significant measures to promote compliance and transparency,” said Girish Navani, CEO and co-founder of eClinicalWorks. “We are pleased to put this matter behind us and concentrate all of our efforts on our customers and continued innovations to enhance patient care delivery.”
Navani, along with CMO Rajesh Dharampuriya and COO Mahesh Navani are liable for the payment of $154,920,000, while developer Jagan Vaithilingam is on the hook for $50,000 and two project managers, Bryan Sequeira and Robert Lynes, each owe $15,000, the Vermont DOJ said.
The lawsuit was originally filed by whistleblower Brendan Delaney, who at the time was a software technician at the New York City Division of Health Care Access and Improvement. He will receive approximately $30 million as part of the resolution.
Wellness Trends for 2017
Well-being is becoming nothing short of a global movement, as consumers seek to ensure healthy lives for as long as possible—particularly as average life-spans continue to rise. The Global Wellness Institute estimates that the worldwide wellness industry grew by 10.6 percent to $3.72 trillion between 2013 and 2015, while the global economy shrank -3.6 percent—making it one of the world’s fastest-growing markets.
In 2017 the “Well Economy” shows no signs of slowing. There’s an ever-growing connectivity in the minds of consumers between the various aspects of their lives. Sleep is linked to productivity, beauty, and mental health. Food is linked to aging, healthy guts, cognitive abilities and stress. Fitness is about mental agility, neuroplasticity and experience—not just firm buttocks. Equinox gyms even offer a mind-body HeadStrong exercise class.
Meanwhile, brands in every category from real estate to hotels are framing themselves in wellness terms.
So what’s new?
The rise of at-home blood testing is bringing entirely new dimensions to the tracking of personal health. Once the preserve of elite athletes, custom blood panels have received a wellness-themed makeover rooted in taking control of one’s own health and longevity. This follows the launch of gene-testing services such as 23andMe, offering DNA-based health assessments and machine-learning personal health and insurance programs from Silicon Valley.
InsideTracker, one of today’s most popular options, analyzes up to 30 different biomarkers, including vitamin levels and cholesterol, from a vial of blood. The InsideTracker platform offers users specific sleep and diet advice to address any deficiencies. InsideTracker’s biggest competitor, WellnessFX, runs a similar service. In November 2016, WellnessFX launched its first at-home testing kit, the $111 Lifelong Vitality package, which monitors key markers of women’s health.
As consumers seek 360-degree wellness, we’re seeing enterprising new players reposition themselves with a wellness angle. There are wellness holidays, wellness hotels, wellness hotel showers. Next on the list is wellness real estate.
Lake Nona, a development on the edge of Orlando, Florida, has been designed with its residents’ health and wellness in mind. A cluster of medical and research facilities known as Medical City provides employment to many of the town’s 11,000 residents, expected to grow to 25,000 before long. The medical centers will soon be joined by a 63-acre home to the United States Tennis Association, with 100 courts on site. Residents of Lake Nona participate in health studies, have access to free activities including tai chi, bike races and yoga, and can stroll along a network of trails that will eventually total 44 miles.
With big-name Instagram fitness trainers selling out rock star-sized arenas around the country, could the next extension of the rock-star model be a fitness Coachella? Already, outdoor mass yoga classes draw big crowds at Burning Man. Nike, one of the biggest names in athletics, is exploring ways to meld the fitness zeitgeist with today’s demand for experience culture. In August 2016, the brand held a three-day immersive fitness event in London that was part-music festival, part-endorphin extravaganza, thanks to its exercise classes. Guests could participate in high-intensity workouts from company trainers or guest celebrity fitness gurus, while visual displays were put on and an electronic soundtrack was supplied by electronic duo Hot Chip.
Marijuana for well-being
With this rising holistic view of well-being, we’re seeing new lifestyle products connecting themselves to wellness. Marijuana is being repositioned for a female audience, not only as aspirational, but also as a form of complementary therapy that can soothe muscle pain, be taken with botanicals as a relaxing bath product, or used as a massage oil ingredient.
Whoopi & Maya, a collaboration between Whoopi Goldberg and Maya Elisabeth, is a line of cannabis-infused edibles designed to treat menstrual cramps. It comes as part of a suite of luxuriously packaged products, which includes Soak, which contains Epsom salts, essential oils and medical marijuana to create the ultimate relaxing bath. There’s also Rub, a medical cannabis body balm with healing herbs and nourishing oils to ease muscle pain.
In fact, marijuana may be on its way to overtaking wine as the hip indulgence of choice. In West Hollywood, White Rabbit High Tea hosts a chic tea party for women, with a focus on vaporizers rather than hot drinks. Gourmet edibles, including Défoncé dark chocolate bars and Angel Haus cannabis ice cream, mean you can also bring the party home. Marijuana accessories are even getting a high-end feminine makeover from brands such as AnnaBís, who designed a chic handbag with concealed pockets for lighters or vapes.
California Joins States That Protect Patients Against Nasty Surprise Bills
Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica, Calif., hospital and surgeon were in his health plan’s network. They were.
Even in the hospital, Orsi dutifully wrote “No out-of-network doctors” across the top of Powers’ admission paperwork.
Her diligence was for naught.
Powers, 57, suffered serious complications, resulting in a two-week hospital stay that included visits from several specialists. It also resulted in a barrage of surprise medical bills from some of those specialists charging out-of-network rates.
The bills total about $5,600 — so far.
“It’s overwhelming,” says Orsi, 64, who lives with Powers in Topanga Canyon. “I feel like consumers are at a major disadvantage.”
Starting next month, many Californians will be protected against such surprise medical bills from out-of-network providers, also known as “Balance Billing."
California is among 21 states with consumer protections against balance billing, says Betsy Imholz, director of special projects for Consumers Union. But many states’ protections are “quite limited,” she says.
“In some states, they only apply in emergency situations or for certain types of plans” such as HMOs, says Claire McAndrew, director of campaign strategy for Families USA, a national consumer advocacy group.
However, in a handful of states, including New York, Florida and now California, the laws are strong and comprehensive, McAndrew says.
Under California’s new law, if you visit an in-network facility — such as a hospital, lab or imaging center — you will be responsible only for your in-network share of the cost, even if you’re seen by an out-of-network provider.
The law applies to non-emergency services received on or after July 1.
“This is a very big deal,” says Tam Ma, legal and policy director for the advocacy group Health Access California. “We’ve heard from hundreds of consumers who were getting these surprise bills.”
A 2015 Consumers Union survey found that nearly 1 in 4 Californians who visited a hospital or had surgery in the previous two years were charged an out?of?network rate when they thought a provider was in?network.
Here’s a common scenario: A patient takes pains to ensure her hospital and surgeon are in-network, only to get billed by the out-of-network anesthesiologist who appears at her bedside to put her under.
“No one gets to pick their anesthesiologist,” Ma says. “It depends on who is on duty, who is available.”
Surprise bills also often come from pathologists, radiologists and assistant surgeons — other providers that patients typically can’t choose, she says.
The new law covers Californians with private health insurance plans that are regulated by the state Department of Managed Health Care (DMHC) and the state Department of Insurance, which includes roughly 70 percent of the state’s private insurance market, according to the California Health Care Foundation. (California Healthline is an editorially independent publication of the California Health Care Foundation.)
It does not cover some 5.7 million people whose employer-sponsored insurance plans are regulated by the U.S. Department of Labor.
Insurers, health care providers and regulators are working furiously behind the scenes to hash out some details about that law, including how much out-of-network providers should be compensated for their services.
But that shouldn’t affect you.
“Is it going to be pretty as plans and providers figure this out in the background? Maybe not,” says Charles Bacchi, president of the California Association of Health Plans. “But what’s important is that it’s not readily apparent to the consumer.”
The key point to remember is that you shouldn’t pay more than your in-network copayment, coinsurance or deductible, as long as you visited an in-network facility for non-emergency services.
So, if you receive what looks like a bill from a provider showing an out-of-network rate, don’t panic, says Imholz, of Consumers Union.
First, read it carefully. It may not actually be a bill. Under the law, any communication to the patient from an out-of-network provider before that provider gets the consumer’s in-network cost information must say — in bold, 12-point type — that it is “not a bill.”
“If it’s an out-of-network doctor, they shouldn’t be claiming that you owe anything right away,” Imholz says.
And don’t pay anything until you receive an Explanation of Benefits from your insurer, experts advise.
When you do receive it, inspect it. If you think you’re still being billed incorrectly, call your health plan and file a grievance, says Mary Watanabe, DMHC’s deputy director of health policy. Your plan will have 30 days to resolve the problem.
If your plan doesn’t resolve the situation within that time frame, or you’re dissatisfied with the decision, it’s time to call your regulator. For most of you, that will be DMHC: 888-466-2219. To reach the Department of Insurance, call 800-927-HELP.
You can also call your regulator before you hear back from your health plan, particularly if out-of-network providers are hassling you for payment.
If you inadvertently paid an out-of-network provider more than he or she is owed, all is not lost. The doctor has to refund the overpayment within 30 days, Ma says. Otherwise, interest starts to accrue.
One warning: The law allows out-of-network providers to bill you out-of-network rates, but only if you voluntarily sign a form at least 24 hours before you receive care, Imholz says. The form must include an estimate of your cost and explain that you can receive care from an in-network provider instead, she says.
“You don’t have to sign it. It’s completely voluntary.”
If you actually do want to be seen by an out-of-network provider and are willing to pay the out-of-network charges, you still have to sign the consent form.
Shrimp, Corn and Avocado Salad with Cumin-Lime Dressing
- 2 spray(s) cooking spray, divided
- 1 pound(s) uncooked shrimp, medium-size, peeled and deveined
- 1/2 tsp table salt, divided
- 1/2 tsp ground cumin, divided
- 1 cup(s) yellow corn on the cob, kernels removed (or 1 cup frozen, thawed corn)
- 1 medium poblano chile, seeded, diced (about 1 cup)
- 2 Tbsp olive oil
- 2 Tbsp water
- 2 Tbsp fresh lime juice
- 1/8 tsp black pepper, freshly ground
- 2 Tbsp cilantro, fresh, chopped
- 6 cup(s), shredded romaine lettuce, shredded
- 1 cup(s) grape tomatoes, red and/or yellow, halved
- 1 item(s), medium avocado, Hass, chopped*
- 1 small uncooked red onion(s), chopped
Coat a large nonstick skillet with cooking spray; heat over medium-high heat. Add shrimp; sprinkle with 1/4 teaspoon each salt and cumin. Cook, stirring often, until lightly browned and cooked through, about 4 minutes; remove to a plate.
Rinse or wipe skillet clean. Off heat, coat with cooking spray; heat over medium-high heat. Add corn and poblano; increase heat to high and cook, stirring once or twice, until corn and poblano are golden in spots and crisp-tender, about 5 minutes. Remove from heat; set aside.
In a large bowl, whisk together oil, water, lime juice, black pepper and remaining 1/4 teaspoon each salt and cumin until blended; stir in cilantro. Add lettuce, tomatoes, avocado, onion, sautéed corn and poblano; gently toss to mix and coat. Top with shrimp and serve. Yields about 2 1/2 cups salad mixture and 3 1/2 ounces shrimp per serving.
We still have some availability for involvement in our upcoming Golf Tourney at Harding Park! Details Below:
Pricing available HERE.