Finances: Page 137
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Deep Dive
Medicaid ACOs on the rise, despite challenges
With 19 states now using some form of a Medicaid ACO, the model comes with both promises and challenges.
By Judy Packer-Tursman • June 16, 2014 -
Do insurers have unfair advantage over hospitals buying doctor practices?
What happens as hospitals and health insurers continue to acquire physician practices, and hospitals are held to a stricter legal standard on paying fair market value?
By Judy Packer-Tursman • June 16, 2014 -
OIG demands $9.8M Medicare refund extrapolated from few claims
The audit revealed that about half of an Ohio hospital's 228 claims under review were compliant. But the rest of the claims spelled big trouble — after auditors extrapolated the hospital's penalty into the millions.
By Judy Packer-Tursman • June 16, 2014 -
Enrollment in private exchanges rising
Providers can expect to see a much higher percentage of out-of-pocket collections from patients with employer-based coverage as a result.
By Katie Bo Williams • June 12, 2014 -
Hospitals, unions face changing landscape under reform
Nurses and other unionized workers are striking, picketing and holding rallies across the U.S. This is nothing new and within their rights. But the reform law is changing the environment in ways that may heighten challenges to keep the peace.
By Judy Packer-Tursman • June 12, 2014 -
How the ACA impacts hospitals: The Henry Ford example
How is the Affordable Care Act affecting health systems' bottom lines? If you ask Detroit's giant Henry Ford Health System, things were OK in 2013 but should improve this year.
By Judy Packer-Tursman • June 12, 2014 -
New payment models to surpass fee-for-service by 2020
The new study by McKesson suggests two-thirds of payments will be value-based in less than 10 years — which worries providers much more than payers.
By Judy Packer-Tursman • June 12, 2014 -
Who are the largest nonprofit U.S. hospitals?
This year the largest nonprofit hospital in the U.S. has 2,259 beds. While some regard hospital bed counts as significant, others say improvements in care delivery mean fewer beds are required. Just how important are bed counts?
By Judy Packer-Tursman • June 12, 2014 -
Provider coalition opposes competitor's acquisitions
Massachusett's largest health system wants to expand, and the state AG's office is obliging. But rival providers are crying foul and urging full public disclosure prior to the deal's final approval.
By Judy Packer-Tursman • June 12, 2014 -
HHS allows new delay for some SHOP exchanges
Small businesses 'employee choice' option on health plans will wait until 2015 in 18 states with federally facilitated SHOP exchanges. The implications for hospitals remain unclear.
By Judy Packer-Tursman • June 11, 2014 -
Mercy Health System to lay off 300 across four states
The hospital blames the layoffs on state-level refusal to expand Medicaid, indicating that even large systems are not immune to the impact of recalcitrant legislatures.
By Katie Bo Williams • June 10, 2014 -
AMA pushes for physician-led care models
Doctors want to take charge of health-care delivery, leading teams serving primary-care needs through value-based care models such as ACOs. Where does this leave hospitals in the fast-changing market?
By Judy Packer-Tursman • June 10, 2014 -
Hospitals see surge of ER patients under reform
Medicaid expansion was intended shift the newly insured into primary care and away from the ER, but in some states, the opposite is happening. What factors are playing into this unexpected situation, and how can it be corrected?
By Judy Packer-Tursman • June 10, 2014 -
VA audit reveals 57,000 vets await appointments
But does the audit show the full extent of systemic problems? How much will VA's outlined emergency fixes actually help?
By Judy Packer-Tursman • June 9, 2014 -
Deep Dive
The Highmark Health gamble: How risky is insurer-hospital integration?
After purchasing a Pennsylvania health system, Highmark Health posted a $186 million loss in 2013 and may lose the leading area provider from its network. What happens next, and what does the Highmark story mean for the trend of vertical integration?
By Judy Packer-Tursman • June 9, 2014 -
Health care doubles average monthly job growth in May
Economic indicators point to a good start to 2014 for the hospital sector. Will the good news continue?
By Judy Packer-Tursman • June 6, 2014 -
Are hospitals that buy oncology practices grabbing extra profits?
A report says hospitals buying oncology practices have increased their purchases through a federal drug discount program meant for low income Americans — with almost half of such hospitals pocketing savings.
By Judy Packer-Tursman • June 6, 2014 -
Why consumers are ignoring health cost data
The industry push for transparency is based on the theory that high deductibles will drive patients to get more involved in health pricing and quality... but that may be a false assumption.
By Anne Zieger • June 5, 2014 -
Are Medicare Advantage plans being overpaid by billions?
Another study says "yes," blaming unjustifiably high risk scoring for plan members — but the industry fires back. Is the increase in risk scores due to MA plans' aggressive billing or a sicker patient population?
By Judy Packer-Tursman • June 5, 2014 -
Medicaid expansion boosts some hospitals' revenue
And the numbers are striking. One hospital in Seattle expects to see an additional $20 million this year alone — double its initial projection.
By Judy Packer-Tursman • June 4, 2014 -
Medicare to cover hepatitis C screening, but not in the hospital
With 17,000 Americans infected annually, CMS wants to protect adults from the virus — if they go to the right care setting.
By Judy Packer-Tursman • June 4, 2014 -
Medicare Advantage bids hint at 2015 changes
Health plans submitting Medicare bids by the June 2 deadline faced tough choices, and the result is shrinking provider networks, premium hikes and benefit cuts.
By Judy Packer-Tursman • June 3, 2014 -
CMS updates Medicare hospital charge data
The update is part of a suite of new data products released in the name of transparency — but will they be useful?
By Katie Bo Williams • June 3, 2014 -
AmSurg to purchase Sheridan Healthcare for $2.35B
The combined company will include more than 4,600 physician relationships in 38 states — and may reflect the future of health care M&A in 2014.
By Katie Bo Williams • May 30, 2014 -
Upcoding to blame for $6.7B in Medicare overpayments?
The OIG concluded that 26% of 2010 claims reflected a higher level of severity than what was justified by the patient's record, indicating a widespread (and very expensive) problem.
By Anne Zieger • May 30, 2014
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