Policy & Regulation
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'Medicare for All' likely to keep private payers, but erode margins: Moody's
Several reports this week game out the costs and benefits of Democratic 2020 presidential hopefuls' healthcare proposals.
By Ron Shinkman • Oct. 18, 2019 -
Health IT advisory group targets price transparency, data security with eye toward 2020
HITAC members floated the idea of establishing a workgroup focused solely on price transparency, with one panel member calling it an area of "high interest, especially for consumers."
By Rebecca Pifer • Oct. 17, 2019 -
Key committee pitches adding UDIs to insurance claim forms, called 'huge step'
If a unique device identifier is captured when a high-risk product is implanted, providers will be able to detect complications more quickly, said Joe Drozda, the director of outcomes research at Mercy Health.
By David Lim • Oct. 16, 2019 -
Sutter settles antitrust case, terms unknown
The agreement, reached just as the landmark trial was set to begin, is expected to be finalized in February or March.
By Dana Elfin • UPDATED: Oct. 18, 2019 at 8:51 a.m. -
Overwhelming majority of providers loathe prior authorization requirements, survey shows
HHS is attempting to address the issue, proposing a rule in June to update electronic prior authorization requirements in Medicare Part D plans. The head of ONC has also called for an overhaul of the process.
By Shannon Muchmore • Oct. 16, 2019 -
Medicare, Medicaid hospital payment cuts to hit $252.6B, industry study finds
"Hospitals are nearing the tipping point we have predicted for so long," Chip Kahn, CEO of the Federation of American Hospitals, said of the report commissioned by his group and AHA.
By Linda Wilson • Oct. 16, 2019 -
Pelosi plan would cut Medicare drug spending by $370B, CBO says
The proposal to require direct price negotiation between the federal government and the pharmaceutical sector stands little chance of quick action, but drugmakers are on defense nonetheless.
By Jonathan Gardner • Oct. 15, 2019 -
California bill to end excessive dialysis profits becomes law
Fresenius said it's concerned the new law will result in patients only being able to access care at hospitals due to lack of insurance coverage.
By Susan Kelly • Oct. 15, 2019 -
Oscar files appeal in battle with Florida Blue over exclusive broker policies
A federal judge ruled against the startup last month, despite the U.S. Department of Justice arguing the case should not be tossed.
By Samantha Liss • Oct. 15, 2019 -
Hospitals, manufacturers could donate cybersecurity software under proposed regs
With the cost of protecting systems from malicious hackers increasing, the idea to tweak the anti-kickback laws recognizes some physician practices don't have the resources or expertise to keep pace, one lawyer said.
By David Lim • Oct. 14, 2019 -
CMS issues 2020 star ratings for Medicare Advantage plans; Kaiser dominates
Centene and WellCare did not fare so well as the two attempt to wrap up their merger, a finding one analyst called "less-than-inspiring."
By Ron Shinkman • Oct. 14, 2019 -
Premier joins forces with Amphastar on 7 drugs in short supply
The agreement is another example of how healthcare companies are searching for new ways to address drug shortages.
By Kristin Jensen • Oct. 11, 2019 -
Appeals court judges skeptical of Medicaid work rule aims
During oral arguments in D.C. on Friday, a three-judge panel pressed for answers on why beneficiaries were losing coverage under the new requirements.
By Samantha Liss • Oct. 11, 2019 -
For COPD patients with high deductibles, more trouble getting care
Authors of the study said plans that "raise out-of-pocket costs or give individuals more 'skin in the game' could harm patients."
By Shannon Muchmore • Oct. 10, 2019 -
Providers mostly cheer anti-kickback revamp but some still wary
The Medical Group Management Association said the proposals fall short, citing a need for clarity on imaging, physical therapy and laboratory services as well as an overhaul of penalties.
By Samantha Liss • Oct. 10, 2019 -
Fresenius to pay $5.2M to settle Medicare overbilling allegations
DOJ alleged the company overbilled Medicare for more than seven years by ordering hepatitis B tests for patients it knew to be immune to the virus.
By Nick Paul Taylor • Oct. 10, 2019 -
With new report, ICER puts itself at center of drug pricing storm
Pharma price hikes added billions of dollars to U.S. spending in 2017 and 2018. For seven top drugs, the watchdog found those increases came with little new clinical evidence in support.
By Ned Pagliarulo • UPDATED: Oct. 8, 2019 at 1:03 p.m. -
HHS pitches sweeping revamp of Anti-Kickback Statute, Stark Law
The department proposed several new safe harbors to encourage value-based care, allow patient engagement through furnishing of tools and supports and permit certain remuneration in some CMS-sponsored models.
By David Lim • Oct. 09, 2019 -
Colorado's public option plan cuts provider rates to lower premiums
The state hospital association immediately slammed the proposal as akin to government rate-setting with "the potential to significantly damage the health insurance market in our state."
By Rebecca Pifer • Oct. 09, 2019 -
Former FDA chief Gottlieb predicts Trump-pitched pricing model easy to game
"I don't want to give too much away, because I'll tell people how to game around this," said the former commissioner, who now sits on Pfizer's board of directors.
By Andrew Dunn • Oct. 09, 2019 -
As docs ditch primary care to become hospitalists, MedPAC warns of shortage
The number of hospitalists increased nearly 50% between 2010 and 2017 while the number of PCPs is basically flatlining, according to a new report from the Medicare advisory commission.
By Ron Shinkman • Oct. 07, 2019 -
Waste gobbles up 25% of US healthcare spending, JAMA study finds
In accompanying editorials, former CMS officials lamented that many initiatives aimed at cutting unnecessary spending haven't been that successful and blamed the political landscape.
By Dana Elfin • Oct. 07, 2019 -
Healthcare leads the way as US hits lowest unemployment mark in decades
"[T]he combination of strong demand growth from healthcare employers and shortages of many clinicians (nurses, physicians) creates a positive set-up for the healthcare temp staffing industry," Jefferies analysts wrote.
By Shannon Muchmore • Oct. 07, 2019 -
Trump signs executive order bolstering MA in pushback on 'Medicare for All'
The directive would let commercial Medicare plans offer more novel benefits and allow beneficiaries to join in on some of the savings payers are able to deliver through cash or rebates.
By Samantha Liss • Oct. 03, 2019 -
Ramping up rhetoric against 'Medicare for All,' Trump looks to bolster popular MA program
Though administration officials were light on details, they said an executive order the president will sign Thursday aims to expand access to healthcare providers and the latest therapies.
By Samantha Liss • Oct. 03, 2019
