• Julie Barnes

December 10, 2021

Maverick's Update

Only What Matters In Information Policy

It is that most wonderful time of the year when everyone asks you “are you ready for the holidays?” What is that, some sort of test? NO we are not ready for the holidays. We are all insanely busy with end-of-year everything and that is a truly ridiculous question. Even Netflix isn’t ready, if the best they could do was “A Castle For Christmas” -- where Brooke Shields is inexplicably allowed to render unfunny and unromantic scenes with the dashing Cary Elwes (who played Westley in Princess Bride). More on who else isn’t ready in the One Thoughtful Paragraph.

Some health policy news that demonstrates a lack of readiness:

  1. Providers are not ready to abide by the No Surprises Act dispute resolution process, as evidenced by their lawsuit challenging the new arbitration process that will settle disagreements about what health plans must pay when their enrollees receive medical services from out-of-network providers.

  2. Experts are not ready to endorse the newly announced policy that individuals with insurance can get reimbursement for an over-the-counter COVID-19 lab test by their health plan.

  3. Advocates for more widespread use of telehealth services are not ready to give up the fight to convince Congress to permanently expand coverage and flexibilities so people can access health care beyond in-person visits.

One Thoughtful Paragraph

The most important holiday film is (obviously) Die Hard, where Bruce Willis plays an estranged husband who is not ready to let his marriage reconciliation plans be thwarted when weirdly well-armed and witty terrorists (nod to the late and great Alan Rickman) attack his wife’s employer during the company holiday party. The health care industry is similarly not ready to execute the myriad of interoperability and price transparency mandates for hospitals and payers (see more here) that are rolling out in quick succession. In a formal notice published today, CMS acknowledged the challenges associated with at least one of the mandates and declared that no well-armed terrorists (we are paraphrasing) will come after payers who are unable to implement the payer-to-payer data exchange rules (see different paraphrasing here, here). CMS also said it wasn’t ready to act on several other items, but it was “exploring” how to handle all of the other not-yet-released rules about streamlining the prior authorization process, USCDI updates, implementing TEFCA, and how to use FHIR standards to make future requirements possible (like an Advanced Explanation of Benefits). Just like Bruce Willis, who could have used more help from the federal agents that showed up at the terrorist scene, the industry could use additional help and guidance from its federal agency on all of this. We try to keep these blog posts clean, but -- when you're ready -- see inappropriate and hilarious one-liners from the movie here.

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