The Latest
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GAO finds 'small number' of payers dominate private, ACA markets
The three largest payers in most states owned 80% or more of the private market in 2016, with even more concentration in state ACA exchanges up to 2017, the watchdog agency said.
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Ascension's longtime CEO Anthony Tersigni to retire at year's end
Tersigni will continue to serve on the executive committee overseeing the St. Louis-based hospital operator's investment fund and will also provide consulting services.
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Hospital-acquired sepsis cases drop, but treatment costs rise, report finds
Sepsis-related mortality and readmission rates also fell, but the average per-case cost of treating the infection went up by 20% to $70,000, according to a new analysis from Premier.
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OpinionOscar Health: a rebel brand without a cause
Daniel Black from brand strategy consultancy Vivaldi on why 7-year-old payer Oscar Health is all flash and little substance.
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Payer participation in ACA exchanges lacks in parts of US
In the Northeast, 40% of the population lives in an area with at least five ACA plan payers. That figure is only 4% in the South, according to the Urban Institute.
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MIPS participation in year 1 nets 95% of eligible clinicians
Of those participating in the Merit-based Incentive Payment System in 2017, 93% earned a positive payment adjustment, according to a new CMS report.
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Several states in CMMI model made 'significant strides' in pop health integration
A new report on the progress of the State Innovation Model found participating states focused on value-based payments, along with integrating behavioral, physical and population health.
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Most health apps share data with third, fourth parties, BMJ analysis warns
"Clinicians should be conscious of privacy risks in their own use of apps and, when recommending apps, explain the potential for loss of privacy as part of informed consent," the study authors wrote.
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Nearly 70% of air ambulance transports in 2017 put patients at risk of balance bills, GAO says
Air ambulance providers and insurers admit the share of out-of-network transports are high, but said they've recently entered into more in-network deals.
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Electronic prior authorization merits wider adoption, health IT, payer groups say
New data show the practice led to faster turnaround times and higher dispense rates than traditional requests by phone or fax.
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10K nurses in New York plan strike over staff shortages
Mount Sinai, Montefiore and NewYork-Presbyterian health systems charged the union with bad faith bargaining on the same day the strike was approved.
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Specialty drug costs skyrocketed to $32.8B in Medicare Part D in 2015
Brand-name specialty drugs accounted for only 1% of all prescriptions dispensed in both Medicare Part D and Medicaid, but made up about 30% of net spend.
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Employee engagement key as hospitals poised for change, Press Ganey says
Healthcare organizations with higher levels of workforce engagement score better on safety grades and patient satisfaction ratings, according to a new white paper.
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Big changes to substance abuse privacy rule coming, sparking renewed debate
Some providers argue Part 2 is redundant and overreaching. HHS Deputy Secretary Eric Hargan called the rule "onerous" last week and hinted a rework is coming soon.
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Payers, employers pitch fixed reimbursement rates for out-of-network providers to curb surprise billing
Hospital groups quickly slammed the proposal as "a dangerous precedent" that could "create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks."
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Sage's postpartum depression drug is approved. Now comes the hard part
Zulresso's label requires women to undergo a 60-hour infusion and only in certain settings, factors that may hamper the drug commercially.
UPDATED: March 20, 2019 at 9:12 a.m. -
Doctors report being mostly happy despite administrative burdens, survey finds
Still, 28% of respondents said administrative duties affect workplace satisfaction, according to a new CompHealth/American Academy of Family Physicians poll.
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Short-term plans, Medicaid waivers, MA benefits dominate AHIP conferences
A House panel is investigating short-term "junk plans" and payers look to take advantage of more flexible benefit options in Medicare Advantage. That (and more) from AHIP's dual conferences last week.
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Managing high-cost claims tops employer benefit plan concerns
Companies are also offering their workers more perks like telehealth, according to a new Mercer cost trends survey.
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Healthcare execs worried about business model disruption, survey shows
Risk aversion, integrating social determinants of health and rising consumerism are also catching the attention of C-suites in 2019, according to a new survey commissioned by Change Healthcare and the HealthCare Executive Group.
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Patients mostly accept EHRs but privacy worries remain
Younger adults are less worried about health record privacy than other age groups, with 42% feeling "very" or "somewhat" concerned about unauthorized access, according to a new poll from the Kaiser Family Foundation.
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Apple heart study: early proof of concept or a bit of a gimmick?
Doctors at the American College of Cardiology conference said the Apple Watch's foray into health monitoring needs more data to prove its value.
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Medicare, Medicaid advisory commissions alarmed by DSH cuts
The latest reports to Congress from the payment advisory commissions call for a sweeping redesign of quality measurement programs and signal concern for the financial viability of disproportionate share hospitals.
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Physician-led ACOs leaving Medicare program in greater numbers
The vast majority of ACOs have stayed with the Medicare Shared Savings Program, however, with only 13% of them dropping out last year.
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Direct enrollment for ACA plans may lead to higher costs, fewer protections
The Center on Budget and Policy Priorities warned that direct enrollment through entities other than HealthCare.gov or state exchange websites stifles competition and can confuse and mislead consumers.
