The FLATLINING Podcast from Fulcrum Strategies
The FLATLINING Podcast from Fulcrum Strategies brings you great healthcare news analysis and discussion each week from industry experts who know their way around politics, economics, and a doctor’s office. Questions about payor issues, Medicaid expansion, or the No Surprises Act? We’ve got you covered. New episodes drop every Wednesday morning.
Episodes
Wednesday Mar 27, 2024
Ep. 82 - Artificial Intelligence in Radiology (with Matthew Stephens, MD)
Wednesday Mar 27, 2024
Wednesday Mar 27, 2024
Today on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon have a conversation with Matthew Stephens, MD, a board certified radiologists at Radiology of Indiana.
Dr. Stevens, Matthew, and Ron discuss the exciting topic of artificial intelligence in healthcare, particularly AI's influence in radiology. They discuss what some of the pitfalls are of using the new technology and what might be coming next.
--
Dr. Matthew Stephens is a board-certified Body Imager with a cardiothoracicradiology specialty who joined Radiology of Indiana in 2023. He received his B.S. in Chemistry from Indiana University, Bloomington, IN. He also received his M.S. in Computer Science from Purdue University, Indianapolis, IN, along with another M.S. in Physiology from Indiana University, Indianapolis, IN. His medical degree is from Indiana University School of Medicine. He also finished a fellowship in Medical Informatics from the Regenstrief Institute, Indianapolis, IN.
--
Follow Matthew on X and LinkedIn.
Follow Ron on LinkedIn.
Wednesday Mar 20, 2024
Ep. 81 - Congress acts on Medicare cuts & Aledade allegedly commits Medicare fraud
Wednesday Mar 20, 2024
Wednesday Mar 20, 2024
In this episode of the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss Congress’ late fix to eliminate part of the cut to Medicare physician fee schedule. They also discuss a recent report about a whistleblower case that alleges major accountable care organization Aledade engaged in serious Medicare fraud.
--
Follow Matthew on X and LinkedIn.
Follow Ron on LinkedIn.
--
Articles mentioned in this episode:
Congress nixes part of the Medicare cut - Matthew Handley at FLATLINING.net
Aledade accused of Medicare fraud in whistleblower lawsuit - Modern Healthcare
Aledade’s statement on whistleblower lawsuit
—
A previous version of this episode had an inaccurate title and an inaccurate description of a former executive at Aledade. Those errors have been corrected. This episode has also been updated to include a statement from Aledade.
Wednesday Mar 06, 2024
Ep. 80 - Addressing Burnout (with Damian McHugh, MD)
Wednesday Mar 06, 2024
Wednesday Mar 06, 2024
Today on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon have a conversation with Damian McHugh, MD, an emergency medicine physician who is now a manager advisor at Curi in Raleigh, North Carolina.
Dr. McHugh, Matthew, and Ron discuss the important topic of burnout and the extremely negative effects that it is having on physicians and patients alike. Dr. McHugh shares some of his own experience and shares why he became a physician. And they discuss what are some possible solutions fix this problem.
--
Dr. Damian McHugh is a longtime NCMS member who practiced emergency medicine for 21 years in Raleigh, NC, and now serves as Managing Director, Physician Liaison, for Curi—a full-service advisory firm dedicated to helping physicians in medicine, business, and life.
--
Articles mentioned in this program:
On Point: Responding to Burnout Today (Without Burning Out Ourselves) - Damian McHugh, MD in the North Carolina Medical Society
--
Follow Matthew on X: @radioHandley
Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.
Wednesday Feb 28, 2024
Ep. 79 - Medicare Advantage payers tell CMS they need more money
Wednesday Feb 28, 2024
Wednesday Feb 28, 2024
Medicare Advantage continues to be one of the most profitable sectors of the health insurance industry, yet a lobby group backed by the nation's largest payers has claimed the federal government isn't paying them enough. Fulcrum Strategies President and CEO Ron Howirgon and Matthew Handley discuss this.
Plus, Elevance-owned Anthem BlueCross BlueShield in New Hampshire has royally screwed up their mail-order pharmacy benefits for NH's retired employees.
Matthew and Ron also discuss why UnitedHealthcare and UNC Health are possibly going to go non-par on April 1.
Subscribe wherever you get your podcasts or at www.FLATLINING.net.
Follow Matthew on X: @radioHandley
---
Articles mentioned in this program:
Payers urge 'stability' from CMS on Medicare Advantage - Becker's Payer Issues
Anthem under fire for 'massively screwed-up' Medicare Advantage contract implementation - Becker's Payer Issues
UnitedHealthcare, UNC Health near split date - Becker's Payer Issues
Wednesday Feb 14, 2024
Ep. 78 - Lawmakers look to remove site of service differences
Wednesday Feb 14, 2024
Wednesday Feb 14, 2024
This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a proposal in Washington to remove the site of service differential. Removing that change would pay doctors the same regardless if a procedure is performed at a hospital or an office.
Ron and Matthew also discuss if the Medicare fee schedule is going to change, a PhRMA's lawsuit against the Biden administration over drug price negotiations, and a Florida health plan that now owes the Federal Trade Commission $195 million.
Listen wherever you get your podcasts or subscribe at FLATLINING.net.
---
Articles mentioned in this program:
In Fight Over Medicare Payments, the Hospital Lobby Shows Its Strength - KFF Health News
Judge tosses PhRMA lawsuit over Medicare power to negotiate drug prices - STAT
FTC obtains $195M judgment against Florida payer, imposes healthcare ban over 'bogus' product - Becker's Payer Issues
Wednesday Feb 07, 2024
Wednesday Feb 07, 2024
On today's episode of the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a current US Supreme Court case that is looking at COVID-19 misinformation and free speech. Namely, the justices are evaluating if misinformation is protected speech. Matthew and Ron discuss what this could mean for physicians who think they are giving their medical opinion to patients or to the public on social media.
Plus, Ron and Matthew discuss a new list from JUST Capital that lists Cigna and Elevance as two of the nation's most "just" companies. What does that even mean?
Listen wherever you get your podcasts or subscribe so it is delivered to your email weekly at www.FLATLINING.net.
Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.
Articles mentioned in this episode:
Supreme Court to weigh whether Covid misinformation is protected speech - STAT News
2024 Overall Rankings - JUST Capital
2 payers among the 'most just' companies - Becker's Payer Issues
Wednesday Jan 31, 2024
Wednesday Jan 31, 2024
In our continuing series on prior authorization, Ron Howirgon and Matthew Handley discuss a press release from Cigna detailing all the "good" reasons big insurers like it use prior authorizations. They claim it is to save patients money but ultimately, it saves patients' lives.
But a new law in New Jersey seems to fly in the face of that saying in its introduction that prior authorizations can be detrimental to patient health in the name of saving money. Matthew and Ron explain.
Listen wherever you get your podcasts or subscribe so it is delivered to your email weekly at www.FLATLINING.net.
Articles mentioned in this episode:
Prior authorizations help keep patients safe, improve health, and make care more affordable - Cigna Healthcare
New Jersey signs prior authorization reform bill into law - Becker's Payer Issues
Bill Text: NJ A1255- Legiscan.com
Wednesday Jan 24, 2024
Ep. 75 - CMS goes after lengthy prior authorizations
Wednesday Jan 24, 2024
Wednesday Jan 24, 2024
This week on the FLATLINING Podcast, Matthew and Ron talk about a new Centers for Medicare and Medicaid Services rule that requires insurance companies to respond to prior authorization requests for certain products within seventy-two hours. Those products include Medicare, Medicaid, CHIP, and Obamacare plans. Unfortunately, commercially insured patients are left out in the cold. Ron shares his concerns with the rule but acknowledges it's a step in the right direction.
Plus: An update on the 2024 Medicare fee schedule - Is the cut still happening?
Listen wherever you get your podcasts or subscribe so it is delivered to your email weekly at www.FLATLINING.net.
Articles mentioned in this episode:
Biden administration cracks down on prior authorization - The Hill
CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process - CMS.gov
Wednesday Jan 17, 2024
Ep. 74 - Some PA residents can appeal denied claims to the state
Wednesday Jan 17, 2024
Wednesday Jan 17, 2024
This week on the FLATLINING Podcas from Fulcrum Strategies, Matthew and Ron discuss the current situation with the Medicare fee schedule. Unfortunately, a cut was not removed by Congress and doctors are now being paid (on average) 3% less to see Medicare patients. Ron shares his insights into what he thinks will change in the next few weeks.
Then, Matthew and Ron discuss a story that was previously shared on Matthew's Friday Pulse Check newsletter (subscribe at FLATLINING.net). The Pennsylvania Department of Insurance has launched a new website that allows patients to submit claims they believe were improperly denied by their insurance company. Matthew and Ron share who is eligible for this service and whether or not this is a step in the right direction to combat massive claim denials.
Read the original story here: PA launches website for patients to dispute denials - Matthew Handley
Wednesday Jan 10, 2024
Ep. 73 - Updates on Cigna’s failed merger and selling its Medicare Advantage
Wednesday Jan 10, 2024
Wednesday Jan 10, 2024
This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howirgon discuss the failed Cigna / Humana merger and why Wall Street analysts thought it was a bad idea from the start. They also talk about the potential buyer for Cigna's Medicare Advantage business and why it doesn't really matter in the grand scheme of Medicare Advantage plans. Matthew also asks Ron what he's looking at in 2024.
The FLATLINING Podcast is a production of Fulcrum Strategies, a provider-focused healthcare consulting company that specializes in making sure providers are being paid fairly by the insurance companies. Learn more at FSDOC.com.
Articles mentioned in this episode:
Cigna abandons pursuit of Humana, plans $10 billion share buyback - Reuters
Cigna pulls out of blockbuster deal to create insurance giant with Humana - The Financial Times
Cigna Nears Deal to Offload Medicare Business - The Wall Street Journal
Cigna, HCSC near deal on Medicare Advantage business: WSJ - Healthcare Dive
About Fulcrum Strategies
Fulcrum Strategies is a health care consulting firm specializing in payer contract negotiation and strategic planning for physician practices founded in 2004 by Ron Howrigon, a former managed care executive. After 18 years working for various national payers, Ron became disillusioned with what he saw happening to physicians, particularly their declining reimbursement. In founding Fulcrum, Ron’s goal was to provide medical practices with professional negotiation resources in order to produce better managed care contracts for medical professionals. Almost two decades later, our organization has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.