Uganda President Yoweri Museveni said on Saturday the government was implementing an overnight curfew, closing places of worship and entertainment, and restricting movement into and out of two districts affected by Ebola for 21 days.
The measures aimed at curbing the spread of the disease will be introduced immediately in Mubende and Kassanda districts in central Uganda, the epicentre of the epidemic, he said in a televised national address.
"These are temporary measures to control the spread of Ebola. We should all cooperate with authorities so we bring this outbreak to an end in the shortest possible time," Museveni said.
Museveni said 19 people have died since the east African nation announced the outbreak of the deadly hemorrhagic fever on Sept. 20.
Things have gotten so bad in New York City that drug dealers are brazenly selling what appears to be cocaine — sometimes neatly assembled on sidewalk tables — on Broadway in trendy NoMad and farther north in Times Square.
Some of the drug-slingers openly solicit, saying, “Weed, coke. Weed, coke” as pedestrians walk by, a disgusted local restaurateur said.
The Post observed two different buyers approach dealers on the corner of West 27th Street and Broadway earlier this month and hand over cash in exchange for plastic baggies containing a mysterious white substance.
And in Times Square, a Post journalist spotted a makeshift table with what appeared to be pre-rolled joints on West 41st Street — and was told by the dealer that they could get cocaine there too.
In NoMad, one man wearing an Amazon vest did not even bother hopping off his bike before riding off with the goods on Oct. 7. A few minutes later, another man approached the dealers and walked away with a white substance in a baggie.
Some dealers neatly assemble their haul on sidewalk tables.
“They’re here before we open and when we close,” said Hannah Dolin, an employee at Aubi and Ramsa, which sells alcohol-infused ice cream and is near where the dealers set up shop
The transactions took place less than 24 hours after three police cars sat near the location the night before.
As of Thursday, the 13th Precinct this year had received 41 narcotics-related 911 calls and another 311 drug-related complaint covering two square blocks flanking Broadway, from West. 27th Street north to West 28th Street and from 5th Avenue west to Sixth Avenue, police said.
The stretch of Broadway has long attracted drug dealers, observers say, but they’ve become especially bold in the last year, laying their goods out on coffee and folding tables as if they’re selling fake Rolex watches or Coach bags.
One cluster of dealers on the northwest corner of West 27th Street and Broadway relax in chairs in front of one of the empty storefronts, directly across from a matcha tea shop and a popular Sweetgreen eatery.
Some of the drug-slingers openly solicit, offering “weed, coke” to pedestrians as they walk by.
The Post on Tuesday observed three people sitting outside the storefront and going into a backpack — which said “I Can Do Anything” — to get their merchandise. A small folding table displayed bags of what looked like weed and pre-rolled joints.
The stretch of Broadway has long attracted drug dealers, observers say, but they’ve become especially bold in the last year.
A police car pulled up in the late afternoon and the crew scattered, grabbing the merchandise off the table.
“It’s like so brazen, I couldn’t believe it,” said one NoMad resident.
The resident said he felt like he was watching an episode of “The Wire” — the award-winning drama series about Baltimore’s out-of-control drug dealers.
One alleged dealer was “sitting up against the store, has a huge plate of loose marijuana and is packaging it into individual baggies,” the resident said, noting he saw the activity late on a Saturday afternoon.
That evening, when the resident saw that the group hadn’t dispersed, he approached a police officer sitting in a patrol car nearby. He said he pointed out the drug dealing and said the cop “just shrugged his shoulders and said ‘What do you want me to do?’ “
“It doesn’t seem like there’s anybody holding anybody accountable. It’s just lawless,” the resident said.
The manager of a nearby upscale restaurant said fights sometimes break out on the corner.
“There are altercations. The cops will show up, usually because someone will call them, and then they’ll make themselves scarce,” the manager said.
James Mettham, head of the Flatiron NoMad Partnership, said the new sidewalk displays are disturbing.
“It’s one thing to be kind of covertly trying to sell marijuana,” Mettham said. “Just flopping down and selling on a table is a step too far for us.”
He said the organization was working with the 13th Precinct but despite NYPD enforcement efforts the drug dealing “kind of creeps back in on a day to day basis.”
The group has been working to bring new shops and restaurants to the area. Broadway is now a pedestrian plaza for two blocks south of 27th Street and there is a new Ritz Carlton hotel on 28th Street where rooms start at about $1,500 a night.
The manager of a nearby upscale restaurant said fights sometimes break out on the corner.
A jewelry store owner near 28th Street said the dealers were hurting his sales.
“Obviously it affects our business,” the shop owner said. “Sales are going down, right now we are 40 percent down.”
He said he’s seen people getting aggressive and arguing and that he closes his door and tells the peddlers not to smoke.
“They made it legal. What can you do?” he said.
New York legalized the personal use of pot in March 2021 but it has yet to issue state licenses to sell weed legally for recreational use. Cocaine remains illegal and having the drug with the intent sell it is a felony.
Michael Alcazar, a former NYPD detective and adjunct professor at John Jay College, said the legalization along with a decline in undercover officers and criminal justice reform measures have emboldened dealers.
A police car caused the merchants to grab their stash and scatter.
“I think the street dealers are trying to push the envelope as far as they can see how much they can get away with before NYPD starts enforcing these drug laws,” Alcazar said.
He said if dealers are arrested “with all the bail reform, again, they’re not afraid of being prosecuted. … There’s just no equating the punishment with the crime anymore. And I think that’s what’s giving life to this underground economy with the drug sales.”
Busts for felony drug sales fell by 28% in the Big Apple from 2019 to 2021, with convictions dropping 52% during the same span, The Post has reported.
Meanwhile, major crime in the 13th Precinct, which includes NoMad and Gramercy Park, is up 25% through Oct. 9 compared to the same period in 2021 with a 29% rise in burglaries and a 9% increase in felony assaults.
As of Thursday, the NYPD had issued 41 criminal summonses this year — including 12 for selling marijuana and five for unlicensed vending — along the two-square blocks bordering West. 27th Street, West 28th Street, Fifth Avenue and Sixth Avenue. Cops say they have also made 10 drug-related arrests on the same turf and other 21 that included burglary and assault.
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An NYPD spokesperson said the precinct’s commanding officer is “aware of the condition at the location and has been working with precinct personnel to address it.”
Medicaid does not have to cover the cost of gender-affirming care in Florida, a federal court judge ruled.
As Politico reports, Judge Robert Hinkle denied a preliminary injunction against a state rule that bans Medicaid from paying for gender-affirming care. The injunction request had been filed by a coalition of transgender rights groups that argued Florida violated the equal protections clause of the U.S. Constitution.
Hinkle did not agree, saying the issue is whether Medicaid law has been violated, not the constitutional rights of transgender people. The transgender rights groups also argued that the Florida ban violated anti-discriminatory rules under the Affordable Care Act.
As Politico reports, Hinkle said that “there’s nothing wrong with the state saying they will approve treatment for this and not that. The question here is about the Medicaid statute.”
Simone Chriss, an attorney with the Southern Legal Counsel in Florida who’s one of the lawyers representing the transgender groups, tells The 19th, an online not-for-profit news site that focuses on gender politics, that while Hinkle’s decision is disappointing, the fact that the judge cited Medicaid means that could be a better way to challenge the ban.
The 19th reports that the state rule, created by the Florida Agency for Health Care Administration and that went into effect in August, disproportionately affects low-income trans people.
The injunction had been sought on behalf of August Dekker, Brit Rothstein, a 12-year-old transgender girl called “Susan” in the lawsuit and a 13-year-old, K.F., who is a transgender boy.
Jade Ladue, K.F.’s mother, tells The 19th that she worries that her son’s stomach pains and night terrors might return if gender-affirming care halts because of the Medicaid coverage ban. She tells The 19th that “we live pretty much paycheck to paycheck at this point. There’s no way we could afford a few grand every month, a couple months.”
About 10 states block Medicaid coverage for gender-affirming care. That care can include hormone-blocking medications, behavioral therapy and surgery.
Demand for gender-affirming care among young people has been growing for some time. A Fierce Healthcare article from 2016 reported that “the demand for transgender medical care, including counseling, hormone treatments and genital surgery, is exploding. The more than 30 clinics that provide care for transgender youth across the country are struggling to keep up with the demand."
However, such services have not been without controversy. This year, pediatric hospitals that perform gender-affirming care to minors have been the target of social media harassment campaigns that have led to threatening phone calls, emails and online messages. False accusations from social media users with large followings have led major provider groups including the American Academy of Pediatrics, the American Medical Association and the Children’s Hospital Association to call on the feds to step in.
Medicaid redeterminations loom with the likely end of the COVID-19 public health emergency, and with that many people could lose coverage, a major concern, UnitedHealth Group executives said on Friday.
Tim Spilker, chief executive officer of UnitedHealthcare Community & State, told investors on the company's earnings call Friday that the team is working from the assumption that the PHE will end in January is is currently scheduled, and then redetermination will resume in the first quarter of 2023. He said the insurer plans to release additional specifics around determinations next month.
Under the public health emergency, states were granted a higher matching rate in Medicaid if they did not drop anyone out of Medicaid or CHIP coverage. When the PHE ends, states will be left to determine who should remain eligible for the program, and experts have estimated the process could take a year. UnitedHealthcare is aiming to be proactive in working with state partners on redeterminations, Spilker said.
"This will be a big lift for states," Spilker said.
UnitedHealth Group CEO Andrew Witty said that the redetermination process would be a "huge setback" in terms of the progress made to boost coverage nationally. More people are covered by some kind of insurance now than ever have been, he said.
The redetermination cycle "could lead to a situation where folks get dislodged from their coverage," Witty said. The Kaiser Family Foundation estimates that 5.3 million and 14.2 million enrollees could lose Medicaid coverage when redeterminations resume.
UnitedHealth Group beat the Street with $5.3 billion in profit for the third quarter, according to the company's earnings report released Friday morning.
For comparison, the healthcare giant reported $4.1 billion in profit in the prior-year quarter. The company also surpassed Wall Street's expectations on revenue, with $80.9 billion in the third quarter, according to Zacks Investment Research. That's up 12% from $72.3 billion in revenue in the third quarter of 2021.
Through the first nine months of the year, UnitedHealth Group has reported $15.35 billion in profit and $241.4 billion in revenue. Through the first three quarters of 2021, UnitedHealth Group posted $13.2 billion in profit and $213.8 billion in revenue.
“The strength of our performance reflects the diligence and determination of our colleagues to improve people’s experience across the health care system and make high-quality care simpler, more accessible and more affordable,” said Witty in the company's earnings release.
nitedHealth Group said the boost in revenue reflects significant growth at both UnitedHealthcare and Optum. At UnitedHealthcare, revenues grew 11% year over year to $62 billion. The number of people served by UnitedHealthcare has grown by 850,000 over the first three quarters, including 185,000 new lives added in the third quarter.
While this year's growth is led by expansion in community-based and senior offerings, UnitedHealth said it's also added 100,000 people to its commercial plans over the past six months.
Revenues at Optum, meanwhile, grew by 17% year over year, reaching $46.6 billion, the company said. That growth was once again led by Optum Health, which has been a consistent highlight for Optum over the past several quarters.
Revenue per customer at Optum Health grew 31% compared to the prior-year quarter, backed by both the expansion of value-based contracts and growth of its care delivery platforms. Revenues for Optum Insight, the company's data analytics arm, grew 18%, UnitedHealth said, and revenues at Optum Rx, the company's pharmacy benefit manager, were up 8%.
Thanks to its performance in the quarter, UnitedHealth Group boosted its guidance for the year to between $21.85 and $22.05 in earnings per share. In premarket trading, the company's stock price rose on the back of the strong third-quarter results.
Payers the world over expect to see healthcare benefits costs jump in 2023 to their highest level in 15 years, but they’ll rise less in North America than in other parts of the world, according to a survey by Willis Towers Watson.
In addition, the 257 leading insurers representing 55 countries put some of the blame for the increase on two other healthcare stakeholders: providers and beneficiaries. Providers because they overprescribe and recommend too many services to patients, and members because of their poor lifestyle choices.
Add inflation to the mix, and insurers expect global healthcare benefits cost to rise 10% next year.
(Willis Towers Watson)
“The one region where a decrease in trend is expected is in North America, projected to drop from 9.4% in 2022 to 6.5% in 2023,” according to the survey’s executive summary. “While this would be welcome news, U.S. employers in particular are not necessarily seeing this impact them yet and remain very concerned on cost and volatility—despite the fact that inflation overall may be abating for the coming year.”
The unprecedented worldwide COVID-19 pandemic continues to present unprecedented challenges to payers. Eric McMurray, WTW’s global head of health and benefits, warns insurers and employers in a press release, that “old solutions will not work. Cost shifting is not an option. There’s a critical need for innovation, strategy and new solutions to have any substantive impact.”
Expected cost increases break down this way:
Latin America, from 18.2% to 18.9%
Asia Pacific, from 6.9% to 10.2%
Middle East and Africa, from 10.5% to 11.5%
“Even Europe, which has traditionally seen much lower levels in the past, is not excluded from the record levels of trend,” the executive summary states. “For 2023, the Europe trend is expected to increase to 8.6%, which is a significant jump over 2021 levels (5.6%).”
The 10% increase comes on the heels of an 8.2% increase in 2021 and an 8.8% increase in 2022.
In addition, payers don’t as yet see an end to the trend, with 78% expecting health benefits cost to increase significantly in the next three years. Insurers blaming the overuse of medical services by providers for cost increases rose from 64% in 2021 to 75% this year. In addition, 52% of respondents blame the poor lifestyle choices by members for the increase, a big jump from the 35% who said that last year.
COVID-19 casts a shadow over the survey when insurers were asked about specific conditions that drive costs. Musculoskeletal disorders ranked first for which claims were filed. “This finding likely reflects the ongoing impact of poor ergonomics in employees’ home working environment combined with reduced levels of physical activity during the pandemic,” the executive summary states. Cancer, the fifth leading condition in terms of claims filed in 2022, will most likely move up to No. 2, which the WTW survey attributes to all the delays in diagnosis and care that COVID-19 forced.
Then there’s mental health. “In our 2022 study, mental and behavioral disorders were ranked among the top five conditions by cost but not by incidence of claims,” the executive summary states. “Respondents expect mental and behavioral disorders to be among the top five fastest-growing conditions by both incidence of claims and cost in the next 18 months.”
Seventy percent of insurers called contracting with provider networks the most effective way to control costs.
“A notable shift over prior year occurred in the area of preapprovals for scheduled inpatient services, which dropped from number two (67%) last year to number five (52%) this year,” according to the executive summary.
In addition, telehealth moved from number three to number two as one of the best cost-cutting techniques, even though the percentage dipped a bit from year to year. Last year, 63% of respondents said telehealth was a good cost-cutting tool, while this year 60% said so.
Blue Shield of California sued the state’s Department of Health Care Services (DHCS) over an alleged failure to produce documents about how it plans to contract with for-profit health insurers across the nation who want to participate in the state’s Medicaid program, Medi-Cal.
A new law goes into effect in January 2024 that would affect approximately 14.6 million lower-income individuals covered by Medi-Cal. However, the state has failed to document exactly what that impact might be, according to BSC.
Kristen Cerf, president and CEO of Blue Shield of California Promise Health Plan—BSC’s Medi-Cal plan—said in a press release that “we are turning to the court to insist on a full, fair, and robust Medi-Cal procurement appeals process. We believe that the Department of Health Care Services has a duty to get this right and not just rubber stamp its original decision.” The appeal was filed last week in the California Superior Court.
Opponents of the law particularly take issue with the role Kaiser Permanente will play, charging that KP has gotten preferential treatment from the state's health department, DHCS, that allows it to cherry-pick healthier Medi-Cal enrollees, while BSC and other health plans care for sicker enrollees who drive up costs. About 84% of Medi-Cal enrollees are enrolled in Medicaid-managed care plans.
Medi-Cal wants to give KP a separate no-bid contract that would last five years. KP currently covers about 900,000 Medi-Cal enrollees, about 7% of the state’s Medicaid enrollees. KP’s enrollees have switched from employer-sponsored KP Affordable Care Act plans into Medi-Cal and tend to be healthier, critics charge. Under the new process, KP’s share of Medi-Cal enrollees could swell by over 25%.
California Healthline reported in July that a potential 25% increase in Medi-Cal enrollees for KP doesn’t appear in the text of the law and that the “precise magnitude of the intended enrollment increase for KP remains unclear.” California Healthline is a publication of the California Health Care Foundation, a not-for-profit philanthropy organization dedicated to improving healthcare for lower-income individuals.
Proponents argue that KP possesses unique advantages for serving Medi-Cal enrollees. DHCS wants to contract with an AHCSP, or alternate health care service plan, a not-for-profit integrated health system with at least 4 million members in a state, which functions as both an insurer and provider through contracts with pharmacies, hospitals, physicians' offices and other provider services in specific regions.
The law, as signed by California Gov. Gavin Newsom at the end of June, doesn’t mention KP. But one of the iterations of the legislation (PDF) that the state Senate considered said that KP “is the only such plan that meets all of these requirements. By creating a direct contract with Kaiser as an AHCSP, the state will have direct oversight of Kaiser as they step up to provide more care for Medi-Cal enrollees. Just as important, consumers will have a direct link to Kaiser services, without the need to divert funds intended for healthcare services toward administrative purposes, which happens under current subcontracting practices.” Currently, KP’s Medicaid brand subcontracts with local, publicly governed health plans around the state.
Kaycee Velarde, the head of Medi-Cal contracting for KP, argued in the California Healthline article that the deal gives more people access to KP’s “high-quality Medi-Cal managed care plan” that would “improve quality for a broader number of Medi-Cal enrollees.”
The version of the law the state Senate reviewed states that DHCS plans to “enter into a direct contract with Kaiser Permanente (Kaiser) as a Medi-Cal managed care plan within certain geographic regions of the State, effective January 1, 2024, for a five-year contract term, with potential contract extensions. Under the new contract, subject to federal approvals, Kaiser would operate as a full-risk, full-scope Medi-Cal managed care plan, consistent with other Medi-Cal managed care plans.”
Despite Velarde’s assurances, BSC and others want to see the methodology DHCS used to reach its conclusions. “Blue Shield also requested that the state-appointed hearing officer provide more time for the appeals process so that each party to the appeal has the opportunity to review all documents related to the request for proposals,” BSC said in its press release. The state did not provide the documentation and did not grant BSC’s request for additional time to review the material, according to the press release.
Opponents have also argued that KP’s effect on local health plans providing Medi-Cal could be likened to what happens to smaller retailers when Amazon decides to sell similar products: The smaller entities cannot compete, and healthcare services would be less likely to meet the specific needs in different localities.
The law states that an AHCSP would have to widen the reach of Medi-Cal to include someone “who is in foster care in this state” or meets the criteria to be in foster care as well as dual-eligible seniors who qualify for both Medi-Cal and Medicare.
The law requires the AHCSP to “enter into a memorandum of understanding (MOU) with the department, which would include specified standards or requirements and the AHCSP’s commitment to increase enrollment of new Medi-Cal members.”
Critics of the law point out that MOUs are not as legally binding as contracts and don’t provide enough detail. In the BSC press release, Cerf stated that “we have waited in good faith and the Department of Health Care Services is refusing to provide the public information we are requesting or to provide a reasonable amount of time for the appeal process.”
Physicians are already saddled with more paperwork to comply with a new requirement they give patients good faith estimates of care costs, a new survey finds.
The Medical Group Management Association (MGMA) released Tuesday its annual regulatory burden report (PDF) outlining key headaches practices face. While prior authorization remains a top burden, the new requirement in the No Surprises Act to offer good faith estimates has shot up.
“In a time of runaway inflation and unprecedented workforce shortages, the federal government is layering on additional regulatory burdens that, while in theory are beneficial to patients, act more as an impediment to delivering care,” said Anders Gilberg, senior vice president of government affairs at MGMA, in a statement Tuesday.
MGMA surveyed executives representing more than 500 group practices on the administrative burdens they are facing.
The top source of frustration was prior authorization with 81% of executives calling it very or extremely burdensome. However, coming in second was a new source stemming from the good faith estimate requirements at 70%.
Starting this January, providers were required to offer a good faith estimate to any uninsured or self-pay patient detailing what they could be charged for an item or service. The requirement is part of regulations implementing the No Surprises Act, which outlaws surprise medical bills.
A patient can dispute to the Department of Health and Human Services any bill that is $400 or more above the estimate.
In 2023, the estimate must also include information from any co-providers or facilities. This means the estimate will be extended to include any fees related to a surgery or procedure and prescription drug or device charges.
MGMA found that 82% of practices say the estimate requirement increased administrative burden. In addition, 74% of practices don’t have the technical infrastructure ready to comply with the new requirements set to start in 2023.
A key problem with the estimate requirement is that the Centers for Medicare & Medicaid Services (CMS) and Congress fundamentally misunderstand how practices operate, said Claire Ernst, MGMA’s director of government affairs, in a statement to Fierce Healthcare.
“For instance, practices must include the expected charges and service codes for items/services to be furnished during the visit, even when no diagnostic code is available,” she said.
Logistically, a practice would have to offer an un-reimbursable “consultation prior to actually scheduling the service,” Ernst said. This effort could cause confusion for the patient who is “essentially being triaged on the phone. This makes even less sense for new patients who do not have an existing relationship with the practice or for patients who are less capable of ‘self-reporting’ their symptoms.”
MGMA has previously asked CMS to go easy on enforcement until a “standard technical solution” can be implemented to help practices.
“At this moment, we do not have one, and it is unlikely this will happen in the next two or so months,” she said.
MGMA’s survey also showed 82% want more guidance from CMS on understanding how to handle state and federal surprise billing requirements. Another 78% seek more help on creating the estimates.
While the good faith estimates create a new layer of burden for practices, prior authorization—where a provider must first get insurer approval before performing a service or doling out prescriptions—remains the top source of concern for practices.
“Practices continue to face growing challenges with prior authorization, including issues submitting documentation manually via fax or through the health plan’s proprietary web portal, as well as changing medical necessary requirements and appeals processes to meet each health plan’s requirements,” the report said.
The survey found that 82% of practices rated their prior authorization requirements as “very or extremely” burdensome. The issue is compounded by the fact that more commercial and Medicare Advantage (MA) plans are adopting the practice, which can help them cut down costs.
There could be congressional action on this issue before the end of the year. The House passed the Improving Seniors’ Timely Access to Care Act last month, which creates an electronic prior authorization for MA plans. The legislation would also create a process for a quick decision on items or services that already get routine approval from insurers.
