Feb 21, 2020

Axios Vitals

Caitlin Owens

Good morning.

Today's word count is 717, or a 3-minute read.

1 big thing: Surprise billing may be about to get worse

Illustration: Lazaro Gamio/Axios

The problem of surprise medical billing — which Congress failed to solve last year — is about to get worse, thanks to a feud between an insurance giant and a company that employs thousands of doctors, Axios' Bob Herman reports.

The big picture: Parents who have babies in intensive care, women with high-risk pregnancies and people who need anesthesia could receive unexpected bills in the mail as a result of the fight between Mednax, the physician-staffing firm, and UnitedHealth Group.

Where it stands: Certain Mednax doctors could be out of UnitedHealth's network as early as March, forcing UnitedHealth customers to pay the full cost if they see one of those doctors.

  • Mednax's anesthesiologists, neonatologists and obstetricians will be out-of-network for UnitedHealth patients at staggered dates throughout this year in four states: Arkansas, Georgia, North Carolina and South Carolina.
  • Arkansas, Georgia and South Carolina don't have any surprise-billing protections for patients, according to the Commonwealth Fund, while North Carolina has limited protections.

What they're saying: Mednax CEO Roger Medel said on an earnings call that UnitedHealth's terminations "were unilateral, without warning and unprecedented," and that he has reached out to UnitedHealth CEO Dave Wichmann.

  • Medel also said Mednax's "administrative costs of processing those bills and the time and stress for patients receiving and resolving these bills will increase meaningfully," and he is "concerned how these actions may interfere with the ongoing discussions in Washington surrounding surprise billing."

The other side: UnitedHealth says Mednax doctors simply charge too much.

  • "Mednax's charges are more than 60% higher than the average cost of the other doctors that provide similar services in these states," a UnitedHealth spokesperson said.

What's next: While the two sides argue, expect more billing horror stories.

2. Health reform, but for "executive physicals"

A Silicon Valley startup is attempting to make executive physicals — which are frequently offered as part of C-suite compensation — available to a larger audience, STAT reports.

Between the lines: The $3,500 annual membership is cheaper than a $20,000 weekend at the Mayo Clinic, but is still expensive and still subject to the same criticism — mainly that it's unnecessary.

Details: The startup, Q Bio, will offer a 75-minute examination and includes an MRI scan and genetic analysis. More comprehensive (and expensive) options are also available.

  • Major hospitals, by contrast, offer executive physical packages that range from $1,700 to $10,000. Other companies offer even more expensive versions.
  • Q Bio wants its patients to have annual exams so that their health can be tracked over time — something that experts say may not have wide health benefits or save the system money.

The bottom line: It's unclear how many people have paid for such exams since the Q Center opened in Silicon Valley late last year, but the company apparently has already had to create a waiting list.

3. Coronavirus is delaying Chinese surgeries

Illustration: Eniola Odetunde/Axios

The novel coronavirus has put a halt to pretty much every activity in parts of China, including elective surgeries like hip and knee replacements, Bob reports.

Between the lines: Medical device companies are starting to forecast large sales declines in their Chinese markets because people are staying at home.

  • Executives at Smith & Nephew — a device maker with $5 billion in annual revenue, of which $360 million came from China — said elective procedures in its Chinese market fell upwards of 90% in the three weeks of the coronavirus outbreak. 
  • Medtronic officials similarly said the coronavirus will have "a negative impact" in the first part of this year.
  • China represents a small part of Stryker's device sales, and executives said it's "too early to get into details about coronavirus." 

Yes, but: People are expected to reschedule surgeries soon, assuming the outbreak tempers, and regular volumes in China are estimated to resume starting in April.

  • "If someone needs an artificial hip, that demand will still be there in a couple of months' time. The question of course is, how quickly will the situation recover, and what is the capacity in the system to then actually make up for this pent-up demand?" Smith & Nephew CEO Roland Diggelmann told investors yesterday.

Go deeper: Coronavirus slams companies' 2020 sales projections

4. Many unpaid caregivers are in poor health

More than 20% of people taking care of a friend or relative say their own health is only fair or poor, according to the Centers for Disease Control and Prevention.

Why it matters: Unpaid caregiving can be physically, financially and emotionally draining, and the need is only increasing as Baby Boomers age, Axios' Marisa Fernandez writes.

  • But caregivers who are themselves in poor health can only do so much, illustrating the limits of relying on unpaid, volunteer labor.

Go deeper: America's caregiver crisis

5. Coronavirus test problems delay screening

The Trump administration's efforts to allow state and local health labs to test for the coronavirus have been delayed by problems with the CDC's test, Politico reports.

Why it matters: The point of additional screening capabilities is to catch individual cases before they become outbreaks, meaning that the delay could hamper the government's attempt to prevent such outbreaks.

  • Only three of more than 100 public health labs across the U.S. have verified the CDC test for use.
Caitlin Owens