Today on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley take a look at some of the latest healthcare news. First, they discuss changes to the Medicare Advantage rates published by the Centers for Medicare and Medicaid Services; they explain why insurers are saying out of pocket expenses will go up for seniors. Ron …

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 wha…

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. -- Fo…

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 BlueShi…

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 goi…

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 th…

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 …

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 pa…

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, …

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 Medicar…

Our most listened to episode of 2023: In 2023, the nation’s largest health insurers saw several lawsuits brought against them for refusing to cover care under the guise that it was not medically necessary or that physicians did not comply with prior authorizations. This happened to otolayrngologist Dan Hurley and Matthew had the opportunity to inte…

We are continuing the Best of 2023 series on FLATLINING Podcast from Fulcrum Strategies. Weight loss drugs got a lot of hype this year as more were approved by the FDA with very promising results. But, as has been noted by several lawmakers and activists, insurance companies are still refusing to cover the drugs. Ron and Matthew discussed the new d…

This week on the FLATLINING Podcast, we start our best of 2023 countdown with our third most popular program of the year. Ron and Matthew discussed a bill that was proposed in the Indiana state legislature that attempted to regulate how hospitals can do business in the state. That bill was later signed into law by Indiana Governor Jonathan Jennings…

This week on the FLATLINING Podcast from Fulcrum Strategies, economist and CEO Ron Howrigon and Matthew Handley discuss the recent news that health insurance giants Cigna and Humana may merge. They discuss why Cigna's stock price has failed to rebound since the news and why Ron thinks this deal will be approved by the FTC. They also discuss, briefl…

We are continuing our series on the FLATLINING Podcast which takes a look at the healthcare policies of the presidential candidates. One of the Republicans who has some concrete ideas is former United Nations Ambassador and former South Carolina Governor Nikki Haley. Haley has proposed: Raising the Medicare and Social Security age Expanding access …

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss recent reporting that the American Medical Association may lobby to ban corporate medicine. Corporate medicine is the practice of entities owning physicians, such as an insurance company or a large hospital system. They also discuss the potential c…

Yesterday, Reuters reported that Cigna is in talks to sell its Medicare Advantage line of business. Upon the release of the news, Cigna's stock price was down nearly 4% at points and ended the day down 3.85%. As other insurers (namely Humana) aim to get out of their commercial business because Medicare Advantage was much more profitable, how is it …

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss UnitedHealthcare's new variable co-pay product called Surest. They talk about these questions providers and patients may have about the product: What is a variable co-pay plan and how does it work? Why will some doctors cost more than other doctors…

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron discuss a recent move by BlueCross BlueShield of North Carolina to purchase the NC locations of retail healthcare chain FastMed. What does that mean for patients and nieghboring providers? Then, they dive into a recent LinkedIn post by Ron that discussed a call he had with…

The Centers for Medicare and Medicaid Services issued new guidance for the No Surprises Act after the previous guidance was struck down in federal court. In short: the Department of Health and Human Services handed a win to the insurance companies that will surely end up back in court. Fulcrum Strategies president and CEO Ron Howrigon discusses wit…

As we enter the open enrollment period, there is little doubt that you will be seeing ads for Medicare Advantage ads on TV. Several weeks ago on the Friday Pulse Check Newsletter, Matthew Handley broke down the top plans by tv ads in recent years. Regardless if you are a patient or a provider, there are things you ought to know about Medicare Advan…

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon discuss recent actions by the Biden Administration to combat medical debt. The White House announced last week that they would be working to bar medical debt from being reported to the major credit bureaus which would then help patient's credit scores. But…

This week on the FLATLINING Podcast from Fulcrum Strategies, CEO Ron Howrigon and Matthew Handley discuss political holdups to Medicaid expansion in North Carolina. The House wants to separate the Medicaid from the state budget and pass it with a casino bill but the state Senate is refusing to agree. So who gets hurt? Is the state ready to handle m…

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron break down several healthcare news items that are relevant to the business administration of provider practices. They take a look at these stories: Cigna, UnitedHealthcare, and BlueCross BlueShield of Michigan claim they have cut prior-authorizations by 20% - Becker's Paye…

Matthew and Ron dive into the debate on whether Medicare should cover every FDA-approved drug, focusing on the case of Aduhelm and Leqembi, two Alzheimer's drugs. Aduhelm was is not covered by Medicare due to limited effectiveness and high cost. The Centers for Medicare and Medicaid Services announced Leqemebi would be in certain circumstances. Key…

Matthew Handley and Fulcrum Strategies president and CEO Ron Howrigon discuss the recent rulings in the third Texas Medical Association case against the Centers for Medicare and Medicaid Services (CMS), commonly known as TMA 3. Judge Jeremy Kernodle ruled that CMS violated the No Surprises Act by publishing guidelines on the Qualified Payment Amoun…

Matthew Handley and Ron Howrigon discuss the ongoing relevance of COVID, the cost of weight loss drugs in the US, and public opinion on prescription weight loss drugs. Key highlights COVID still matters, especially for those at risk The cost of weight loss drugs in the US compared to other countries The need for a free market economy in healthcare …

We received the news last week that Dr. Dan Hurley, who Matthew interviewed on the FLATLINING Podcast several months ago, had lost his battle with cancer. This week, Fulcrum Strategies president and CEO Ron Howrigon shares how Dr. Hurley's story affected him and continues to motivate him to fight for physicians. You can listen to our entire intervi…

This week on the FLATLINING Podcast, Matthew and Ron discuss a claim made by Senator Bernie Sanders (I-VT) that millions of Americans cannot access a primary care physician or have to wait months to get an appointment. Are these claims true? If so, what can be done? Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app…

This week on the FLATLINING Podcast, Matthew and Ron talk about Senator Amy Klobuchar’s (D-MN) SMART Prices Act which would speed up the drug price “negotiations” in the Inflation Reduction Act. They also talk about an idea that would eliminate the difference in costs between seeing a doctor at a hospital versus and office. Subscribe to the FLATLIN…

This week on the FLATLINING Podcast, Matthew and Ron talk about three current healthcare proposals from three different groups. First, the Biden administration is proposing changes to how short-term health plans work. These were deregulated during the Trump administration and allowed to last 364 days and be renewed four times. Ron explains why that…

This week on the FLATLINING Podcast, Matthew and Ron discuss a few news items in North Carolina. First, the state budget has been held up by members of the state Senate effectively putting Medicaid expansion on hold. When can we see any changes and how many more Medicaid patients should providers expect to see? Then, BlueCross BlueShield of North C…

This week on the FLATLINING Podcast, Matthew Handley takes a look at the “two cents to save America” plan touted by Michigan businessman Perry Johnson. Johnson says it will save America’s debt crisis. Who knew it could be so simple? Plus, Matthew tells you what federal department Johnson wants to cut completely and how his policies affect your heal…

Matthew Handley and Ron Howrigon continue their discussion about Ron’s new book. In this second part of the episode, they discuss what some possible reforms would be to fix the system and save the economy. CLICK HERE TO PURCHASE THE BOOK. (https://amzn.to/3CgXfmt) From the description: With healthcare spending accounting for nearly 20% of the U.S. …

This week on the FLATLINING Podcast, Matthew Handley talks to Ron Howrigon about his new book CLEAR!: Reforming Healthcare to Save the US Economy. In the first of this two-part episode, they talk about some of the reasons healthcare is breaking the economy. CLICK HERE TO PURCHASE THE BOOK. (https://amzn.to/3CgXfmt) From the description: With health…

Yesterday, the 5th Circuit Court of Appeals heard arguments for a case that could end free preventative care in the Affordable Care Act. Listeners of the podcast may remember when Ron and Matthew discussed the first case last year. Judge Reed O’Connor, the federal judge who previously attempted to rule that the ACA was unconstitutional entirely, ru…

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, Californ…

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 …

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, …

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, Googl…

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 a…

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 cau…

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 a…

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 …

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 discus…

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. Subscrib…

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, Spo…

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 cente…

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 Indian…

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. Subscri…