The FLATLINING Podcast

This week on the FLATLINING Podcast, Matthew and Ron provide an update on the debt ceiling talks in Washington. Now that a tentative deal has been agreed to, what delays, if any, can providers expect from Medicare payments? Then, a new budget deal in Sacramento may raise reimbursement for some office visits and maternity care for Medi-Cal, California’s Medicaid program. How much of an increase could physicians see and is it enough to keep doctors in-network for the program? Plus, Democratic lawmakers there are at odds with Governor Gavin Newsom over a tax he collected but then didn’t use. Matthew and Ron break down the fight. 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 program: California wants to increase pay for some Medi-Cal providers. How it might help patients access care - The Press Democrat California Governor and Democratic Lawmakers at Odds Over Billions in Health Care Funds - KFF Health News This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Robert F. Kennedy, Jr. is one of the few Democrats who have decided to mount a primary challenge to President Joseph Biden in the 2024 election. He has espoused conspiracy theories about childhood vaccinations, the use of fluoride in water purification, and COVID-19. At the same time, he pushes for bonafide Democratic policies including protecting the environment and limiting special interest involvement in government. His beliefs may help him draw an interesting mish-mash of progressives disappointed in President Biden and conservatives still upset about COVID-19 policies. Matthew Handley breaks down his policies and their consequences in this special series of the FLATLINING Podcast. He takes a pulse check on Robert F. Kennedy, Jr. Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast, Matthew and Ron discuss a new policy from UnitedHealthcare ($UNH ) that requires diagnostic and surveillance colonoscopies to undergo prior authorization. At the same time UnitedHealthcare claims they are cutting twenty percent of prior authorizations across the board. Then, the Senate Health, Education, Labor, and Pensions Committee passed several new regulations on Pharmacy Benefits Managers, including a prohibition on price spreading. Matthew and Ron discuss that and its impacts on patients. 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 program: ‘Stunning’ change to United’s colonoscopy coverage roils physicians and patients - STAT News Easing the prior authorization journey - UnitedHealthcare Senate panel advances drug pricing bills, including PBM reforms - The Hill Pfizer CEO calls US drug price plan 'negotiation with a gun to your head' - Reuters This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast, Matthew and Ron discuss the debt ceiling. Why does the United States have a debt ceiling? What happens if the US defaults on its debt? How will Medicare claims be paid if the government hits the debt ceiling? 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: What is the debt ceiling? Why it's important and how it affects you - CNBC via Microsoft Start Five things to know about the debt ceiling bill passed by House Republicans - The Washington Examiner via Microsoft Start How Is the 14th Amendment Connected to the Debt Ceiling? - Newsweek This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Dan Hurley, MD is an otolaryngologist in Arizona who has been diagnosed with a rare and fatal form of cancer. While he was preparing to receive chemotherapy, his insurance carrier denied a PET scan. When the decision was eventually overruled, Dr. Hurley had to make the choice to delay chemo treatment and get the scan or start the treatment to try and save his life. Matthew Handley discussed that decision with him, how he has helped his patients in similar situations, and what sparked his initial interest in medicine. 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 program: How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them - ProPublica UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings. - ProPublica Aetna settles suit alleging claim-denying medical director never read patient’s records - CNN This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Dr. Dan Hurley is an otolaryngologist, a husband, and a father. He also has been diagnosed with a terminal form of cancer. While preparing for chemotherapy treatment, his insurance carrier denied a necessary PET scan. Next week on the FLATLINING Podcast, Dr. Hurley shares his story, how he pushed back against his insurance and won, and what he recommends for patients in the same situation. Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

The federal government is appealing the TMA 2 case. What does that mean for TMA 3 and TMA 4? Then, Matthew and Ron discuss the current lawsuits against the FDA and why some politicos want it both ways. Plus, the federal government has spent nearly $1 billion researching long COVID; some say that’s too much with little result. And vaccines don’t cause autism, but do they cause tinnitus? 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 program: FDA About to Make Drug Approvals More Difficult - David Williams via RealClear Policy The NIH has poured $1 billion into long Covid research — with little to show for it - STAT News Tinnitus not tied to COVID-19 shots, CDC says - Becker’s Clinical Leadership and Infection Control Possible links between Covid shots and tinnitus emerge - NBC News This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Today, Judge Jeremy Kernodle is holding hearings on two lawsuits against the Department of Health and Human Services for their lack of enforcement of the No Surprises Act. These two cases regard the proper calculation of the Qualifying Payment Amount (QPA) and the fee hike for submitting claims to the arbitration process; these are known as TMA 3 and TMA 4 respectively. Matthew and Ron are at the EDPMA Solutions Summit 2023 conference in Las Vegas, Nevada where the No Surprises Act is the main topic of discussion. In today’s program they discuss why there are lawsuits to begin with and what some possible outcomes are when the cases are decided. Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast, Ron and Matthew discuss two recent judicial decisions that contradict. A judge in Texas ruled that mifepristone, the drug used for over half of all abortions in the United States, should lose its approval status from the Food and Drug Administration (FDA). Then, on the same day, a judge in Washington ruled that the FDA needs to make the drug more widely available and stop some of its restrictions and warnings. What do these decisions mean for drug manufacturers and the independent practice of medicine? Plus: California backs off of Walgreens and CMS throws some pennies at hospitals. 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: 6 burning questions about how the FDA will handle conflicting abortion pill decisions - STAT Newsom wanted California to cut ties with Walgreens. Then federal law got in way - Desert Sun Hospitals get a slight pay boost - Axios This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Last week the investigative publication ProPublica released an article detailing Cigna’s ($CI ) use of a computer system that automatically denies claims that meet certain parameters. Our own president and CEO Ron Howirgon was interviewed for the article and participated in a ProPublica/The Capitol Forum webinar on the matter. He and Matthew discussed the contents of the article and what can be done to solve this problem in this week’s episode of the FLATLINING Podcast. 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 program: How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them - ProPublica Medically Necessary - ProPublica via YouTube This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast, Ron and Matthew discuss several healthcare news items from California, including Governor Gavin Newsom’s decision to sever the state’s ties with Walgreens ($WBA ), California branded generic insulin, the court cases surrounding the COVID-19 misinformation law, and Sutter Health’s full residency program. 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 program: California to end Walgreens contract after abortion dispute - The Associated Press California picks generic drug company Civica to produce low-cost insulin - The Daily Democrat California's COVID misinformation law is entangled in lawsuits, conflicting rulings - Desert Sun Sutter Health Welcomes Record Number of Residents for Upcoming Year - Global Newswire Sutter fills 100% of residency openings in record match year - Becker’s Hospital Review This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast, Matthew and Ron discuss the new weight loss drug by Novo Nordisk ($NVO ) called Wegovy and how it and similar drugs could change America’s public health. Plus, they talk about why insurance companies aren’t covering it and how and when that could change. 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 program: Ozempic Can Cause Major Weight Loss. What Happens if You Stop Taking It? - The New York Times What to Know About Ozempic, Wegovy and the New Weight-Loss Market - CNET Covering new weight loss drugs could strain Medicare, policy experts warn - STAT News This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast, Matthew and Ron briefly discuss the closures of Silicon Valley Bank and Signature Bank. What do the closures say about the rest of the economy? Then they talk about the deal reached in North Carolina to expand Medicaid and reform the Certificate of Need laws. How soon can a group open an ambulatory surgery center (ASC) or operate and MRI machine? Will this help bring down costs for patients? 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 program: How to get an MRI - Dr. Glaucomflecken via YouTube Bank run scene from It’s a Wonderful Life - YouTube NC House and Senate Republicans reach milestone Medicaid expansion deal, but Democratic governor questions the timeline - NC Health News This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

In this episode of the FLATLINING Podcast, Matthew and Ron discuss two news items. First, they talk about new data that shows more physicians died during the COVID-19 pandemic than previously expected, fueling the already-created physician shortage. What happens if there aren’t enough physicians? Then, they discuss a new bill in the state of Indiana that claims to help regulate some of the state’s largest hospital systems. Ron explains why this proposal is a bad idea. 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 program: Hundreds more physicians died than expected amid pandemic - Becker’s Hospital Review Michael Hicks: HB1004 would restrict hospital monopolies - Daily Journal HOUSE BILL No. 1004 - Indiana State Legislature This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week, Matthew and Ron continue their discussion on the different ideas for reforming healthcare. In this episode, they focus on some of Senator Bernie Sanders’ priorities as the new chair of the Health, Education, Labor, and Pensions Committee in the United States Senate and different proposals to save Medicare from becoming insolvent. 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 program: ‘We Ain’t Gonna Get It’: Why Bernie Sanders Says His ‘Medicare for All’ Dream Must Wait - Kaiser Health News Yes, Social Security and Medicare still need to be reformed — and soon - Editorial Board at The Washington Post This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

On the FLATLINING Podcast this week, Matthew and Ron begin a short series explaining the different proposals floating around in this Congress to “fix” or reform healthcare. In this episode, they discuss some of the contents of House Speaker Kevin McCarthy’s Commitment to America and why some states are attempting to pass a public option. 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 program: The future of health care reform is now - Michael Burgess and Eric Hargan in The Hill States are turning to the public healthcare option. They shouldn't - Sally Pipes in The Washington Examiner This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week, Judge Jeremy Kernodle ruled against the Department of Health and Human Services (again) in a lawsuit surrounding the No Surprises Act. The Texas Medical Association and others were plaintiffs in the case and had previously taken the Biden Administration to court over HHS’ creation of the Interim Final Rule. Last year, Judge Kernodle ruled that HHS had not followed proper procedure and effectively tried to re-write the No Surprises Act with their Interim Final Rule. In August 2022, HHS issued a new Final Rule that the Texas Medical Association alleged had the same intent and effect as the original Interim Final Rule. Judge Kernodle agreed. Matthew and Ron break down the lawsuits and explain why this ruling is a win for doctors and providers. Let Matthew and Ron know what you think about the No Surprises Act. Email them at flatlining@substack.com, tweet Matthew (@radioHandley) or Ron (@RonHowrigon), or leave a comment on this post. 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 program: BREAKING: Providers win in new Texas Medical Association ruling - Ron Howirgon via FLATLINING.net Judge rules on No Surprises Act - Matthew Handley via FLATLINING.net This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

On this FLATLINING Podcast Short, Matthew takes a look back at an episode Ron did in 2020 about then-candidate Joe Biden’s healthcare platform. He focused his healthcare policy on a few things: lowering the Medicare age, adding a public option, drug reform, and surprise billing. Matthew takes a look at how well President Biden has stuck to those campaign platforms ahead of the State of the Union and at the halfway point of President Biden’s first term in office. Let Matthew and Ron know what you think about these policy platforms and how well you think President Biden has done in this regard. Email them at flatlining@substack.com, tweet Matthew (@radioHandley) or Ron (@RonHowrigon), or leave a comment on this post. Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Last week, the US hit the debt ceiling and now Democrats and Republicans are pointing fingers and arguing about what might happen next. The debt ceiling affects the US government’s ability to pay its bills; one of those big bills is Medicare. So, what happens next? Should providers expect to get paid for Medicare services? What about Medicare Advantage reimbursement? Matthew and Ron break it down for you. Plus: A look back at a ballot initiative mandating nurse proportions in Massachusetts, a bill to end the COVID-19 public health emergency, and American views on the healthcare system. 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 program: Manchin says it’s a ‘mistake’ for White House to want Democrats to address debt ceiling without GOP - CNN Biden's new tax hammer - Axios What you need to know about Massachusetts ballot Question 1 - Boston.com More nurses: The smart way to save lives, money — and nurses - STAT Guthrie Introduces Bill to End the COVID-19 Public Health Emergency - Rep. Brett Guthrie (R-KY 2) Americans Sour on U.S. Healthcare Quality - Gallup This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Have these podcasts delivered to your email inbox each week by subscribing. This week on the FLATLINING Podcast, Ron and Matthew discuss the 2023 Medicare fee schedule. Congress, in the omnibus spending bill last year, averted a 4.5% cut by giving providers a 2.4% increase thus bringing the total cut to 2.1%. (-4.5+2.4=2.1). Ron explains how the math is done and what Medicare looks like for 2024. In UnitedHealth Group’s 2022 financial report ($UNH ), it was disclosed that their pharmacy benefit manager (PBM), Optum, earned more profit than their insurance division, UnitedHealthcare. Ron and Matthew discuss how PBMs make their money and what Congress might do about it in 2023. 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 program: Omnibus bill halts PAYGO cuts to providers - Healthcare Finance The PBM defense playbook - Axios 🔒 UnitedHealth Group's 2022 Earnings are in, PBM Optum outperforms health insurance division - Wendell Potter via Wendell Potter NOW This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net