News roundup: UHG’s cyberattack hit now $2.3B, Senate bill on cyberattacks intro’d, VA’s AI tech sprint awards, AliveCor’s new CPT codes

July 18, 2024 | by | No Comments

UHG reported earnings, profit reduced by $1 billion due to Change Healthcare cyberattack costs. On Tuesday 16 July UnitedHealth Group reported Q2 (ending 30 June) earnings of $98.9 billion, up $6 billion or 7% versus Q2 last year. Profit though didn’t move the same way, instead taking a hit at $7.9 billion, down from last year’s $8.1 billion. Despite strong performances in the UnitedHealthcare and Optum units, the drag from the Change Healthcare cyberattack is now estimated at an additional $1 billion from last quarter’s guesstimate, now at $2.3 billion. Also affecting the profit bottom line is inflating healthcare costs that are reflected in rising medical loss ratios (MLRs). Change is also obliged to do the patient notification which will start by the end of this month [TTA 21 June], having already started notifications of hospitals, providers, insurers, and other customers. Release, Healthcare Dive

But hey, now the Senate has a bill to coordinate agencies with the purpose of reducing those darn cyberattacks. The Healthcare Cybersecurity Act, sponsored by Senators Jacky Rosen (D-Nev.), Todd Young (R-Ind.), and Angus King (I-Me.), would direct the Cybersecurity and Infrastructure Security Agency (CISA) and the Department of Health and Human Services (HHS) to collaborate on improving cybersecurity. One important change would be creating an HHS liaison within CISA to coordinate incident response specifically for healthcare entities. An earlier version introduced by Sen. Rosen in 2022, S. 3904 (117th Congress), never made it into committee.  Sen. Jacky Rosen release, Healthcare Finance   But aren’t there other agencies involved in cyberattacks and ransomware like the FBI and the Department of Justice? And international agencies like the NCA and Europol since so many come from the darker parts of Europe and Asia? (The devil’s in the details…)

The Department of Veterans Affairs (VA) is taking a modest dip into the AI ocean. The award late last week of pilots for an AI-assisted healthcare dictation tool went to Abridge AI and Nuance Communications. The non-competitive, fixed-price contracts are as a result of the two companies winning the first track of the VA’s AI Tech Sprint which launched last October. The tools are designed to generate transcriptions from ambient recordings of patient encounters within specialty care, mental health care, and primary care settings, as well as integrating into the Oracle Cerner EHR. The notice does not specify start or end date. There is also a second sprint around developing an AI system to process documents generated in patient-provider encounters and other complex medical documents for continuity of care and sharing information with VA providers. FedScoop

AliveCor received CPT codes applicable to the company’s Kardia 12L ECG System. The Category III Current Procedural Terminology (CPT) codes are assigned by the American Medical Association (AMA).  The 12-lead system a few weeks ago gained FDA clearance for the combination of the Kardia 12L ECG System (left), a single cable with five electrodes that acquires 8 high-quality diagnostic bandwidth leads, with their KAI 12L AI-assisted diagnostic technology for clinician use only. The three new codes will be effective 1 January 2025 and will be published in the 2025 CPT Code book. Release

CMS urged to further reimburse telehealth remote patient monitoring with three new CPT codes

June 14, 2018 | by

The Centers for Medicare & Medicaid Services (CMS), which controls payments to doctors for the Medicare and state Medicaid programs, has been urged by 49 healthcare organizations and technology vendors to further unbundle the controlling CPT code for remote patient monitoring (RPM), 99091. The 2018 Physician Fee Schedule (PFS) Final Rule finally separated RPM from telemedicine remote visits by permitting separate payment for remote physiological data monitoring by unbundling CPT 99091 to reimburse for patient-generated health data (PGHD)–a new term. The letter to Administrator Seema Verma proposes 2019 adoption of three additional American Medical Association CPT Editorial Panel-developed codes which further break down various aspects of RPM, while maintaining 99091. 

CPT codes for Medicare and Medicaid are important because they also influence private insurers’ reimbursement policies. Practices which get paid for RPM are more likely to adopt enabling technologies if they are affordable within how they are paid. 

CMS started to include telehealth RPM in 2015 in a chronic care management code, 99490, but specifically prohibited the use of CPT 99091 in conjunction with CCM. This created a lot of confusion after some brief moments of hope by tying technology to a complex CCM model.

It’s possibly a ‘light at end of the tunnel’ development for hungry tech companies, but one which won’t be determined till end of year when PFS rules are released. Also Healthcare Dive.