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What We're Reading: Surprise Medical Billing Reform; Antiviral Pill Effective Against COVID-19 Variants; Teen Vaping Trends
Consumer protections against surprise medical billing will go into effect January 1; Merck’s experimental oral COVID-19 antiviral drug shows efficacy against variants; an online questionnaire finds a 40% decrease in teen vaping from 2020 to 2021.
Ban on Surprise Medical Billing to Start January 1
As reported by the Associated Press, the Biden administration released rules yesterday on consumer protections against surprise medical billing, with the ban on these charges for insured patients set to go into effect on January 1, 2022. As part of the novel billing process, hospitals, doctors, and insurers will now be responsible for determining fair payment over a 30-day negotiation period if warranted, and if an agreement cannot be reached, an independent arbitrator will decide the cost-effective value of the medical services provided. Moreover, patients will no longer be billed substantially if they undergo care at a hospital emergency department that is closest to them and outside their insurance plan’s provider network.
Merck COVID-19 Pill Effective Against Variants
According to laboratory studies investigating Merck’s experimental oral COVID-19 antiviral drug, molnupiravir, results released Wednesday found the pill was highly effective against variants of COVID-19, including the Delta variant. As opposed to targeting the spike protein of the virus, the main focus of approved vaccines, Reuters reports that the pill instead targets the viral polymerase, which is an enzyme needed for the virus to replicate itself. Data indicated that the antiviral pill was most effective when administered early in the course of infection.
Declining Teen Vaping Trends
Findings of a national survey conducted by the FDA and CDC on teen vaping trends released yesterday showed a dramatic 40% drop in use from 2020 to 2021, according to the Associated Press. In the survey, 11% of high school students and less than 3% of middle school students were indicated to be recent users of e-cigarettes and other vaping products, compared with in 2020 when 20% and 5% were cited as recent users, respectively, and in 2019, which exhibited the peak of use in high school students at 28%. As data were collected via online questionnaire, US health officials urged caution in interpreting the results.
ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Contributor: For Complex Cases, Continuity in Acute Care Is Necessary
April 23rd 2025For patients with complex needs and social challenges like unstable housing, the hospital has become their de facto medical home—yet each visit is a fragmented restart, without continuity, context, or a clear path forward.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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