health care providers :: Article CreatorPeople Leaving Prison Face Many Hurdles. Temple Is Running A Reentry Simulation To Help Health Care Providers Relate
A recent patient of Dr. Valerie Armstead, an anesthesiologist at Temple Health, made a request before he underwent a colonoscopy, a procedure that requires sedation.
As Armstead recalls, he said, "I don't want to have anything that's going to show up on my drug test, because I've been out of prison for a week, and I have to see my parole officer in five days – and if my urine comes up dirty, they're going to act first and ask questions later."
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Armstead had been through a simulation project that replicated the obstacles that people leaving incarceration experience when reentering society. At one point during the simulation, Armstead pulled a card that said she had "dirty" urine, meaning her urine had tested positive for drugs during a mandatory screening and she faced serious consequences, including possible revocation of probation.
"At that moment, I really felt like I was being wronged, and I said, 'OK, this is like being in this other person's shoes,'" Armstead recalled. "And when I had that patient, I felt like, I know exactly what you are talking about."
Armstead's patient was harder to anesthetize because he could not have the drugs she normally would administer for a colonoscopy. "But we got it done. We just worked with him to give him what he needed in order to have this very important procedure," Armstead said.
Provided Image/U.S. Attorney's Office for the Eastern District of Pennsylvania
The reentry simulation taking place Monday at Temple's Health campus, like the one shown above, gives participants pretend roles and asks them to complete various tasks, like finding a job, locating housing and paying bills. It's designed to help people better understand the hurdles faced by people leaving prison.
On Monday, Temple's Lewis Katz School of Medicine is hosting a reentry simulation similar to the one Armstead completed. Armstead, who helped organize the project, said she hopes Temple residents, fellows and medical students, as well as people from outside the university, will gain the knowledge she did about the challenges people face when returning from incarceration.
"It's one thing to have someone explain it to you," said Lori Pompa, founder and executive director of Temple's Inside-Out Center, which brings college students together with incarcerated students for semester-long courses in correctional settings. "It's a whole other thing to experience it."
During the two-hour simulation, participants will walk in the shoes of people just leaving prison. They will be asked to complete a series of real-life tasks within a limited time period, according to the identities they are assigned. They must comply with the terms of their probation, find a job, locate housing, attend treatment and pay bills.
The people going through the simulation will come out with a better sense of the stressors that people reentering society face, said Jacqueline C. Romero, U.S. Attorney for the Eastern District of Pennsylvania.
"When they (clinicians) have someone walking in the door who looks burnt out, run down and on their last leg, maybe they will approach their patients ... With a viewpoint toward getting them the kind of wraparound services that they need," Romero said. "They may be coming in the door because their glaucoma is out of control, but they might need some cognitive behavioral therapy or some family therapy. … If we're all doing our jobs, and we're all coming at this from holistic angles … it's going to help our reentering citizens in tremendous ways. It's going to help them deal with a lot of these life stressors and not make some drastic decisions."
People reentering society after long imprisonments may have developed chronic health issues, Armstead said, noting "the continued stress of being locked up … can really put wear and tear on you."
Provided Image/U.S. Attorney's Office for the Eastern District of Pennsylvania
The image above shows a reentry simulation similar to the one that will be held at Temple's health campus on Monday, May 6. It aims to help people better understand the challenges faced by people who recently were incarcerated.
Once people are on the outside, they may have trouble accessing the necessary health care and medications – or even getting transportation to their doctor's appointments.
A "significant portion of released people actually use the emergency department as their primary care," Armstead said, adding that everyone working in emergency rooms should be more aware of what people returning to society face.
"If you are a surgeon and you have a trauma patient, then after you stitch them up, it's important to try and really be concerned about what happens to them afterwards," said Armstead, who is also a professor at Temple's medical school and has a master's degree in urban bioethics.
"People just have to want to help other people and be genuine about it and not just view it as an assembly line … where we can't have any deviations from the norm," Armstead said. "You may have to take more time with an individual or help them engage the help of other people."
The simulation takes place from 9:15 a.M. To 11:30 a.M. Monday at Temple's Medical Education and Research Building. It is sponsored by the Center for Urban Bioethics at the Katz School of Medicine, Temple's Department of Anesthesiology, the Inside-Out Center at Temple University and the U.S. Attorney's Office for the Eastern District of Pennsylvania. People can use this link to register.
Collusion In Health Care Pricing? Regulators Are Asked To Investigate
Recent revelations about a data analytics firm's role in determining medical payments have heightened concerns about possible price fixing in health care and led to a call for a federal investigation.
In a letter this week, Senator Amy Klobuchar asked federal regulators to examine whether algorithms used by the firm, MultiPlan, have helped major health insurers conspire to cut payments to doctors and leave patients with large bills. She cited a New York Times investigation last month into MultiPlan's dominance of the lucrative business of pricing out-of-network medical claims.
"Algorithms should be used to make decisions more accurate, appropriate and efficient, not to allow competitors to collude to make health care more costly for patients," Ms. Klobuchar wrote to the heads of the Justice Department's antitrust division and the Federal Trade Commission.
When patients see a medical provider outside their plan's network, insurers often send their claims to MultiPlan, which uses proprietary algorithms to recommend how much to pay. By driving down payments to providers, MultiPlan and the insurers can collect higher fees for themselves, The Times reported, but this can lead to higher bills for patients, who may get charged the unpaid balance.
UnitedHealthcare, Cigna, Aetna and other major insurers use MultiPlan's pricing recommendations, and the firm has boasted to investors that it is "deeply embedded" in its clients' claims-processing systems.
In interviews, Ms. Klobuchar, a Democrat from Minnesota, and experts in antitrust law said this arrangement could amount to price fixing: Rather than competing to offer better coverage, insurers could use the low prices recommended by MultiPlan's algorithms, knowing their competitors would likely do the same.
"This should trigger an investigation by the agencies," said Barak Orbach, a law professor at the University of Arizona. "There seems to be a really strong case."
The F.T.C. And Justice Department declined to comment, but both agencies have raised concerns in the past about similar arrangements in other industries.
MultiPlan did not have an immediate comment. But in legal filings, the firm has denied allegations of collusion and said that insurers are free to reject its pricing recommendations or negotiate higher payments with providers.
The firm said in a previous statement to The Times that its work benefits patients and employers who pay for their workers' coverage by "promoting affordability, efficiency and fairness across the U.S. Health care system."
Insurers have said that MultiPlan's tools help combat outrageous billing by some providers, including consolidated hospital systems and private-equity-backed staffing firms.
Documents reviewed by The Times indicate that MultiPlan has sometimes told insurers how their unnamed competitors were using the firm's pricing tools. In a 2017 presentation to UnitedHealthcare, MultiPlan shared "Recent Client Strategies to Improve Results," which included techniques that could reduce payments to providers.
After a 2019 meeting, a UnitedHealthcare senior vice president reported to her colleagues that a MultiPlan executive "did not specifically name competitors but from what he did say we were able to glean who was who." She then described how Cigna, Aetna and some Blue Cross Blue Shield plans were apparently using the firm's pricing tools.
Three hospital systems have sued MultiPlan, accusing it of colluding with major insurers to set unreasonably low payments for medical care, and patients and providers have complained to the F.T.C. About MultiPlan, records obtained through a public records request show.
One provider reported slashed payments from UnitedHealthcare, Cigna and an Aetna subsidiary after the insurers routed claims to MultiPlan's most aggressive pricing tool. Another said the tool "has decimated my life" and caused "the closing of my business," which has "left patients having to travel 2.5 hrs for surgery."
Patients complained to the agency of receiving large bills after insurers used MultiPlan-recommended prices. "This is now affecting my credit score," wrote one patient, describing a bill that had been sent to a debt collector. Another reported being billed thousands of dollars "since they refuse to pay my providers the correct amount."
Pricing algorithms have driven MultiPlan's growth over the past 15 years. The firm previously focused on controlling costs by negotiating with medical providers, but after being sold to private equity investors, it embraced automated, algorithm-based tools, which typically yield lower payment recommendations.
Access to data from hundreds of clients has helped entrench the firm's dominance, executives have told investors. "We build our algorithms on a much larger data lake," one executive said in a 2020 presentation.
The focus on MultiPlan's automated pricing tools highlights growing concern among regulators and some in Congress that algorithms are supercharging price-fixing schemes and driving up costs for consumers.
During the Biden administration, companies' increasing embrace of technological advancements has collided with aggressive enforcement efforts by regulators. The results have been mixed, as the agencies seek to apply laws enacted to combat 19th-century oil and railroad robber barons to 21st-century technology firms.
"Algorithms are the new frontier," the Justice Department wrote in a brief in one case. "And, given the amount of information an algorithm can access and digest, this new frontier poses an even greater anticompetitive threat than the last."
Regulators and some antitrust scholars worry that algorithms can enable sophisticated collusion that is difficult to police. Competitors no longer need to meet in secret to hatch a conspiracy and communicate among themselves to perpetuate it. They can simply agree to use a common pricing algorithm.
Weighing in on private lawsuits involving apartment rents and hotel room prices, the agencies have argued that such an arrangement is illegal, even if competitors agree with a wink and a nod rather than a formal pact.
But in one case, a judge disagreed in a December ruling, allowing the lawsuit to go forward but requiring renters to offer more explicit evidence that landlords had conspired to raise prices using an algorithm.
Ms. Klobuchar has introduced legislation that would effectively make the agencies' position the default. Courts would presume it illegal for competitors to share nonpublic data with a middleman and use the pricing recommendations that the firm's algorithms produced.
"It is not clear whether current antitrust laws are sufficient to stop this practice," Ms. Klobuchar said in an interview. "It is much better just to clarify this and to close the loophole."
The bill would also require companies to tell consumers if they are buying something that was priced using an algorithm, and it would give regulators greater authority to demand details about how an algorithm works.
UnitedHealth CEO Slammed At Senate Hearing On Change Healthcare Cyberattack
WASHINGTON -- Senators from both sides of the aisle tore into UnitedHealth Group (UHG) CEO Andrew Witty, blaming him and the healthcare behemoth for not preventing the cyberattack on Change Healthcare, a UHG subsidiary, and for failing to minimize the fallout for patients and providers, during a Senate Finance Committee hearing on Wednesday.
"I believe the bigger the company, the bigger the responsibility to protect its systems from hackers," said Committee Chair Ron Wyden (D-Ore.), noting that with $342 billion in revenue last year, UHG is the fifth largest company in the U.S.
Change Healthcare is responsible for moving patient data from one physician's office to another, and to and from insurance companies, Wyden explained. A third of American patients' medical records pass through the healthcare clearinghouse, transmitting medical bills with sensitive information pertaining to abortions, mental health disorders, and cancer diagnoses.
The cyberattack on Change Healthcare forced UHG to disconnect the clearinghouse from the rest of the healthcare system, creating a "state of financial bedlam" for physicians across the country, many of whom continued providing services for weeks without pay, he said, adding that insurance companies were unable to reimburse providers, and patient prescriptions went unfilled.
"And Americans are still in the dark about how much of their sensitive information was stolen," Wyden pointed out. "Mr. Witty owes Americans an explanation for how a company of UHG's size and importance failed to have multi-factor authentication on a server providing open-door access to protected health information, why its recovery plans were so woefully inadequate, and how long it's going to take to finally secure all of its systems."
UHG CEO Makes His Defense
In response, Witty explained that when UHG bought Change Healthcare roughly a year and a half ago, there was "an extensive amount of modernization required" due to legacy systems, some of which were 40 years old. "Very unfortunately, this server had not been updated prior to the attack," he said.
Witty also walked through the steps UHG had taken to secure its systems since February 21, when cyber-criminals known as ALPHV or BlackCat encrypted Change Healthcare's systems, blocking access to them. UHG immediately disconnected Change Healthcare's data centers to prevent further infiltration of the broader health system, he said.
UHG also contacted the FBI "within hours" of the attack, and Witty said he made the difficult decision to pay the $22 million ransom.
"As of today, across the entire UnitedHealth Group, all external-facing systems now have multi-factor authorization," he noted. In addition, UHG has brought an expert from a leading cybersecurity service onto the company's board.
As for the disruptions in payments to providers, Witty said, "our belief, at this point, is that claims flow across the entire country is essentially back to normal."
In regard to the types of information that had been stolen, he said only medical claims information has been identified.
Senators Doubt CEO's Claims
Sen. Marsha Blackburn (R-Tenn.) disputed Witty's statement that claims flow had returned to normal.
"I will tell you this, the reality that hospitals and providers are facing is ... Different from the rosy picture that you have painted," she said.
She pointed to one small independent private hospital in Tennessee that "diligently submitted" its claims, but continues to have a backlog equivalent to 30 days of revenue.
A survey from the American Medical Association conducted from April 19-24 reported that 90% of physician respondents are continuing to lose revenue from unpaid claims, and 80% are losing revenue because they can't submit claims. More than one in four respondents said their practice revenue for the last week was 70% lower than it had been during an average week prior to the cyberattack.
Blackburn said it is "widely acknowledged" that the financial assistance program that UHG implemented has failed to adequately support providers pulling from personal savings and retirement funds and others seeking bank loans to stay afloat.
"Are you going to cover all of those costs that they have had to incur in order to keep the doors open because you did not have an appropriate back-up plan?" she asked.
Witty said he would be "very happy to engage with those providers." Throughout the hearing, he emphasized that UHG has advanced more than $6 billion in interest-free loans. Practices will not be required to repay those loans until 45 days "after their business is back to normal," he noted.
Sen. Maggie Hassan (D-N.H.) raised the issue of why individual patients haven't yet been notified of the breach, pointing out that, by law, patients are supposed to be notified of any breach to HIPAA within 60 days of it being uncovered.
She also pressed Witty on exclusivity contracts that prohibit customers from using more than one company to manage their payments, which "effectively creates single points of failure."
Witty said that UHG agrees that having "business redundancy" is important and that it is releasing customers from the terms of those agreements.
As for other prevention measures, Wyden highlighted that the breadth of the fallout of the attack was in large part a result of healthcare consolidation, calling the Change Healthcare hack a "dire warning about the consequences of too-big-to-fail mega corporations gobbling up larger and larger shares of the healthcare system."
"A comprehensive scrub of UnitedHealth's anti-competitive practices" is long overdue, he added.
Currently, HHS does not require providers, payers, or healthcare clearinghouses to meet minimum cybersecurity standards, but that is something that ought to change, Wyden said. He called on federal agencies to "fast-track new cybersecurity rules" to protect Americans' private medical records, and told reporters that his team is already at work on legislation to address patient privacy issues.
Shannon Firth has been reporting on health policy as MedPage Today's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team. Follow
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