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Treating patients has become more expensive during the pandemic, and doctors and dentists don’t want to shoulder all the new costs.

For example, the box of 100 gloves that cost $ 2.39 in February 2020 now costs $ 30, said Dr. Judee Tippett-Whyte, president of the California Dental Assn., Which has a private dental practice in Stockton.

His practice relied on surgical masks that cost 20 cents each, but switched to N95 masks at $ 2.50 a pop. On top of that, her office schedules two or three fewer patients each day to account for physical distance and give staff members time to disinfect between patients, she said.

“We have suffered a lot of financial costs,” Tippett-Whyte said. “We shouldn’t have to bear the cost for ourselves.”

His argument raises a fundamental question about COVID-19: who should pay the expenses in the event of a pandemic? Should it be healthcare providers facing new protocols in the era of the pandemic or insurance companies, who could pass their extra costs on to customers in the form of higher premiums?

California dentist and doctor lobbies say insurance companies are overwhelmed with cash after collecting premiums during the pandemic, but have paid fewer claims than usual – and should foot the bill. The California Medical Assn., Which represents physicians, sponsored legislation that would require insurers to reimburse medical and dental offices for pandemic-related expenses such as personal protective equipment, disinfectant, and staff time. to screen patients for symptoms before an appointment.

A request by doctors to bill Medicaid and Medicare for supplies and other costs related to the pandemic recently failed at the federal level. But in Washington state, a new law sponsored by the state’s physician lobby is forcing private insurers to reimburse some of those costs.

Insurance trade groups opposed the two state measures.

Reimbursement for the cost of non-medical supplies is generally not the responsibility of insurers, said Mary Ellen Grant, spokesperson for the California Assn. health plans.

“Here we are with processing and office levels at pre-pandemic levels. Now they want extra payment from the plans to pay for non-medical expenses, ”Grant said.

The insurance industry is also emphasizing that doctors and dentists have not had to fend for themselves when it comes to PPE and other pandemic-related expenses. As of April 2020, the US Department of Health and Human Services has distributed $ 9.9 billion to more than 50,000 California medical providers through the Provider Relief Fund, out of $ 178 billion available nationwide.

And more than 900,000 businesses in the “health care and social assistance” category – including some medical and dental offices – have obtained loans from the Small Business Administration’s Paycheck Protection Program since March 2020.

A letter from insurance groups opposed to the California bill points to other aid, such as advance payments on insurance claims from federal and state insurance plans, grants and loans, and programs that distributed free PPE to certain practices.

“They received a lot of help from the federal government to cover these costs,” Grant said.

An analysis released Monday by the Kaiser Family Foundation found that most health insurance companies have become more profitable during the pandemic. Overall, they collected more premiums from members each month than they paid in claims, and spent a lower percentage of premiums on medical claims in 2020 than in 2019. Largest medical insurer The country’s UnitedHealth Group recently reported its net income for the first quarter of 2021 was 44% higher than the same quarter last year.

Allison Hoffman, a professor who studies health policy at the University of Pennsylvania School of Law, said she had little sympathy for the health insurance companies that “made their fortunes over the past year. elapsed ”by collecting premiums without paying the typical number of treatments and doctors. visits.

“We’re starting to see some sort of broader definition of what health insurance might pay in order to keep people healthy,” Hoffman said. “There is nothing like a public health emergency to highlight the fact that sometimes it is not a prescription drug or surgery that is going to improve health.”

At the end of last year, the American Medical Assn. lobbied the Federal Centers for Medicare & Medicaid Services to approve a procedural code that doctors could use to bill these public insurance programs for PPE, disinfection equipment, office changes to separate them people and staff time educating patients before their visits and checking for symptoms. Often, when federal regulators approve a new billing code for Medicare and Medicaid, private insurers also begin to reimburse the corresponding costs.

Allowing doctors to bill for this code would help them follow infection control protocols without further reducing their income, the association wrote to the federal agency.

But CMS rejected the request, saying it viewed paying those costs as part of paying for the rest of the appointment, according to a spokesperson for the agency.

Following this decision, two state medical associations themselves took the case in hand.

Washington State Medical Association. supported a law, which came into effect on April 16, that allows healthcare providers to charge state-regulated private insurance companies $ 6.57 when they see a patient in person – in addition to charging the services they provide – to cover the cost of additional PPE, staff the time and materials needed to perform and transport COVID-19 tests. The new rules last until the remainder of the public health emergency declared by the federal government.

For a law that places the medical association and the state insurance association on opposite sides of the negotiating table, she was remarkably dissatisfied, said Sen. David Frockt (D-Seattle), who presented The law project.

California’s law, which is still debated, is more open than Washington’s.

SB 242 does not specify a dollar amount, but would require state-regulated private health plans to reimburse dental and physician offices for “medically necessary” business expenses associated with a public health emergency.

The California Medical Association. said the medical practice’s revenues fell by a third while the costs of PPE rose 14% in the first six months of the pandemic, according to an October 2020 survey of its members. Of the survey respondents, 87% said they were concerned about their financial viability.

“When you look at the record profits of some of these publicly traded companies and what they are showing their shareholders, that would be a drop in the bucket,” association spokesperson Anthony York told About health insurers. “We’re not surprised that the plans don’t want to pay more, but at the end of the day it’s a fight we’ll have in the Legislature.”

The bill aims to prevent small and medium-sized businesses from closing their doors in the face of rising costs, said its author, Sen. Josh Newman (D-Fullerton). The state’s medical and dental associations warn that anything that adds costs and cuts to revenue could force small practices to close or consolidate, exacerbating shortages of doctors and dentists in the state.

“What I’m doing, as a legislator, is deliberately offsetting some of these heavy costs so that we don’t lose physicians and practices,” Newman said. “It would be a shame if these communities lost access to health care.”

This story was produced by KHN (Kaiser Health News), one of the three main operational programs of the KFF (Kaiser Family Foundation).





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