Medical groups clash over insurance coverage of herbal medicine


By Lee Hyo-jin

A pilot program rolled out by the government to include several types of herbal medicine in treatments covered by national health insurance was welcomed by practitioners of traditional Korean medicine. It, however, immediately provoked backlash from Western medical doctors.

As the government has plans to expand the coverage for more herbal medicine in the future following the progress of the trial program, the mixed reactions of the two medical groups may deepen into another dispute.

Under the pilot program, which started on Nov. 20, patients at traditional Korean medicine clinics who are prescribed treatments for menstrual pain, facial paralysis, or the aftereffects of cerebrovascular diseases, pay only half of the fee for the herbal medicine, as the rest is covered by state insurance.

The three-year test run is aimed at reducing the financial burden of patients and establishing a verified system to ensure the safety and effectiveness of herbal medicine, according to the Ministry of Health and Welfare.

Around 8,700 clinics providing traditional Korean medicine treatments across the country ― approximately 62 percent of the total ― have agreed to participate in the program.

Why Western medical doctors oppose

The announcement was immediately met with strong backlash from the Korea Medical Association (KMA), the largest Western medical doctors’ group in the country with more than 130,000 members. The association strongly condemned the government’s decision through a press release, calling it a “nationwide clinical trial using unverified medicine.”

They argued that easing public access to traditional Korean medicine and related herbal therapy will pose a risk to people’s health as they claim the safety of the treatments have not been adequately verified and there is no scientific evidence for their efficacy.

The association also pointed out that the program may lead to poor quality of herbal medicine, due to a shortage of certified herbal medication dispensaries and lenient control over them. While most small traditional Korean medicine clinics have own dispensaries, some large ones have outside dispensaries make the medicine.

“There are only five outside herbal medication dispensaries in the country certified by the government. This means that those five facilities will be preparing all the herbal medicines for over 8,700 clinics during the pilot program period,” KMA member Kim Gyo-woong said at a press conference, Nov. 23.

“The mass production system may lead to failure in quality control and safety issues, and considering the current lax control over dispensaries, the system may lead to illicit manufacturing of drugs,” he added.

In addition, the KMA stressed that the health authorities should focus more on the unresolved issues surrounding the side effects of traditional medicine.

More than half of medical disputes reported in relation to traditional medicine treatments were about herbal medicine, followed by Chuna manual therapy, acupuncture, and skin care, the association said, citing recent data from the Korea Consumer Agency.

“The government must immediately retract the policy which only puts public safety at risk, and launch a full investigation on all herbal dispensaries and prohibit the operation

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South Dakota medical groups promote masks, countering Noem

SIOUX FALLS, S.D. (AP) — South Dakota’s largest medical organizations on Tuesday launched a joint effort to promote mask-wearing to prevent the spread of the coronavirus as the state suffers through one of the nation’s worst outbreaks, a move that countered Gov. Kristi Noem’s position of casting doubt on the efficacy of wearing face coverings in public.

As the number of cases, hospitalizations and deaths from COVID-19 have multiplied in recent weeks, the Republican governor has tried to downplay the severity of the virus, highlighting that most people don’t die from COVID-19. Noem, who has staked out a reputation for keeping her state free from federal government mandates to stem the virus’ spread, has repeatedly countered the Center for Disease Control and Prevention’s recommendations to wear face coverings in public.

Shortly after the Department of Health reported that the number of hospitalizations from COVID-19 broke records for the third straight day on Tuesday, people who represent doctors, nurses, hospitals, school administrators and businesses huddled to promote mask-wearing, social distancing and handwashing. They warned the state’s hospitals could face a tipping point in their ability to care for COVID-19 patients.

“Masking is a simple act that each one of us can participate in and it can save lives,” said Dr. Benjamin Aaker, the president of the South Dakota State Medical Association. “If you mask, that life could be your mother, father, your friend, or even your own.”

Noem’s spokesman Ian Fury said the governor does not oppose all mask-wearing, but is trying to promote a “nuanced” approach to masks. She has said it is appropriate to wear masks around people with symptoms of COVID-19 or in hospitals. But she has not encouraged people to wear face coverings in public, as recommended by the CDC.


October has already become the state’s deadliest during the pandemic, with 152 people dying. Health officials have tallied 375 total deaths from COVID-19.

The groups calling for mask-wearing detailed the upheaval caused by virus infections — from school administrators struggling to conduct contract tracing to businesses worried about the economic impacts of widespread outbreaks.

The state’s prisons have seen the greatest surge in cases in recent weeks. Roughly one out of every three inmates statewide have an active infection.

The state has reported the nation’s second-highest number of new cases per capita over the last two weeks, according to Johns Hopkins researchers. There were 1,226 new cases per 100,000 people, meaning that one in roughly every 82 people tested positive. The Department of Health reported 989 new cases on Tuesday.

The rise in hospitalizations has forced the state’s two largest hospital systems — Sanford Health and Avera Health — to alter the logistics of some elective procedures to free up space for the influx of COVID-19 patients.

There were 395 people hospitalized by COVID-19 statewide, according to the Department of Health. About 34% of general-care hospital beds and 38% of Intensive Care Units statewide remained available on Tuesday.

Health care providers will hit an unmanageable load of

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HSG Foresees Major Potential Financial Impact on Employed Physician Networks and Medical Groups from 2021 Proposed Medicare Physician Fee Schedule

Healthcare Consultants Urge Hospitals and Health Systems to Start Planning for Impact on Physician Compensation and Medicare Payments for Professional Services.

Neal D. Barker, Partner at HSG, a national healthcare consulting firm is the author of "Changes to the 2021 Medicare Physician Fee Schedule Could Have Major Impact on Physician Compensation." The article is available for download at the website, hsgadvisors.com.
Neal D. Barker, Partner at HSG, a national healthcare consulting firm is the author of “Changes to the 2021 Medicare Physician Fee Schedule Could Have Major Impact on Physician Compensation.” The article is available for download at the website, hsgadvisors.com.
Neal D. Barker, Partner at HSG, a national healthcare consulting firm is the author of “Changes to the 2021 Medicare Physician Fee Schedule Could Have Major Impact on Physician Compensation.” The article is available for download at the website, hsgadvisors.com.

Louisville, KY, Oct. 21, 2020 (GLOBE NEWSWIRE) — HSG, a national healthcare consulting firm, has published a detailed evaluation of the Centers for Medicare & Medicaid Services (CMS) 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule, which is scheduled to take effect on January 1, 2021, if approved in the Final Rule. The advisors at HSG believe the proposed changes may have a significant potential impact on physician compensation and urge healthcare executives to start planning for these proposed changes. The agency’s Fee Schedule changes cover everything from Work Relative Value Unit (wRVU) values for specific Current Procedural Terminology (CPT) codes to changes in the scope of practice policies for Advanced Practice Providers (APPs) and changes related to CMS’s quality payment program.

With more than a 10% decrease in the MPFS conversion factor, services that do not have any change in Relative Value Unit values will see a decrease in Medicare payment at the projected rate of more than 10%. The decreased reimbursement will not be fully offset by any reimbursement increases realized through the Quality Payment Program paths. Changes related to outpatient and office evaluation and management (E&M) service code determinations and requirements, along with permanent and temporary additions to telehealth codes, will add to compensation complications. The redefined E&M code selection criteria will now be driven by medical decision making (MDM) or time spent alone – with no direct contribution by history and/or exam elements.

“Assuming these changes are included when the Final Rule is published in early December, many industry organizations, consultancies, and provider advocacy groups are projecting significant increases in provider productivity-based compensation if the providers’ E&M profile remains unchanged,” explained Neal Barker, Partner at HSG. “Ultimately, hospitals and health systems may face a situation in which payments from Medicare will decrease while their physician compensation requirements will significantly increase based on the widespread use of wRVU-based compensation models for employed physicians and APPs.”

As the roll-out date for the new Fee Schedule grows closer, HSG is working with healthcare systems to help them gain an understanding of the potential impact on the network.  Then HSG works with the organization to build a model to address changes to wRVU targets and bonus conversion factors that yield productive compensation levels that are financially sustainable and uphold fair market value and commercial reasonableness. Coincident with the compensation impact review, HSG conducts a series of provider

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