The AHA today urged the Centers for Medicare & Medicaid Services to use its oversight authority for Medicare Advantage, Medicaid managed care, Children’s Health Insurance Program and Health Insurance Marketplace health plans to prevent UnitedHealthcare from implementing certain diagnostic and specialty pharmacy coverage restrictions for enrollees.
AHA cited concerns with UHC’s Designated Diagnostic Provider program, which “could eliminate coverage for diagnostic tests at most freestanding and hospital labs, and specialty pharmacy coverage policies that “disrupt care for patients with highly complex medical conditions and decrease providers’ ability to control the quality of care for patients.”
AHA also urged the Federal Trade Commission to protect hospitals and consumers from the adverse impact of the DDP program’s coverage policy, and from anticompetitive and unfair practices by nurse-staffing agencies.
“The AHA has received reports from hospitals across the nation that nurse-staffing agencies, which supply desperately needed staff to care for patients suffering from the COVID-19 virus and other conditions that require hospitalization, are engaged in anticompetitive pricing,” AHA wrote. “… Such outrageous rate hikes appear to be naked attempts to exploit the pandemic by charging supracompetitive prices to desperate hospitals. While the nurse staffing agency industry too often blames hospitals for driving up the rates, the fact is that hospitals are in dire need of nursing staff to care for their patients and have little choice but to pay the rates demanded and refrain from complaining publicly for fear of being cut off from the supply of travel nurses by staffing agencies that set the prices.”
It also asked the agency to reconsider an announced retrospective study on physician acquisition and concentrate its resources on COVID-19 related consumer protection issues.