Policy & Regulation

CMS pitches expanding bundled payments for joint replacements

One Wall Street analyst suggested that post-acute care providers, not the manufacturers of pricey medical devices used in surgeries, face the greatest financial risks.
By Ron Shinkman • Feb. 21, 2020
ACOs ask CMMI for more shared savings in direct contracting model

The group asked for more details on the financial methodology to be released immediately, saying members "are finding the lack of information a tremendous hindrance to participation."
By Shannon Muchmore • Feb. 21, 2020
Spending on VA long-term care to double by 2037, government watchdog says

Workforce shortages and geographic alignment of care, particularly for those in rural areas, will make it difficult for the VA to meet the growing demand, according to the Government Accountability Office.
By Hailey Mensik • Feb. 21, 2020
Opaque pricing, data silos still mar interoperability progress, HITAC says

ONC head Don Rucker also teased at the meeting that his agency's part of final rules to promote free exchange of data would be coming soon.
By Rebecca Pifer • Feb. 20, 2020
Price hikes drove employer-sponsored health costs to record high in 2018

The Health Care Cost Institute, drawing on data from Aetna, Humana, Kaiser Permanente and United Healthcare, found higher prices accounted for about three-quarters of the increase, while usage rose just about 3%.
By Hailey Mensik • Feb. 14, 2020
3 surprise billing proposals compared side by side

Congress advanced two proposals last week to ease unexpected medical bills as pressure mounts from consumers. Here are the key elements under consideration.
By Samantha Liss , Shannon Muchmore • Feb. 13, 2020
As SDOH efforts take off, payers try to carve out their role

Signify Community's Jamo Rubin said at a conference this week, "in four years of medical school and then residency, I never learned one thing about what happens to people after they get discharged."
By Rebecca Pifer • Feb. 12, 2020
Rollout of VA's troubled Cerner EHR system delayed

More time is needed to complete the records system and ensure clinicians and other users are properly trained on it. A new launch date will be announced in coming weeks, the agency said.
By Hailey Mensik • Feb. 12, 2020
1 in 5 surgery patients hit with surprise medical bill, JAMA study finds

Anesthesiologist and surgical assistants were associated with the most out-of-network charges. The findings come as lawmakers in Congress debate rival proposals to curb the unexpected bills this week.
By Hailey Mensik • Feb. 11, 2020
Payers, providers on different pages on SDOH, consumerism, value-based care

"In our 10 years of fielding this research, I don’t think we’ve seen healthcare industry leaders so polarized on some strategic issues," said Change Healthcare SVP David Gallegos, "and so tightly aligned on others."
By Ron Shinkman • Feb. 09, 2020
Q&A
One Medical's CFO on why primary care is ripe for disruption

The company's IPO was for 17.5 million shares at $14, the low end of its range. On the listing day Jan. 31, shares jumped to about $20. Since then, the stock price has continued to rise.
By Shannon Muchmore • Feb. 07, 2020
Azar touts 2019 greatest hits, glosses over setbacks in state of HHS speech

He skated over some high-profile efforts from the Trump administration that didn't bear fruit or sparked bad publicity last year, such as efforts to lower drug prices, Medicaid work requirements and cutting away at the ACA.
By Rebecca Pifer • Feb. 07, 2020
CMS proposes changes to Part D drug tiers, real-time benefit info for seniors

The proposed rule would also allow patients with end-stage renal disease to enroll in MA plans starting in 2021. Payer groups, however, voiced concerns about the change.
By Samantha Liss • Feb. 06, 2020
FDA greenlights 1st emergency use coronavirus test

The decision means the diagnostic can now be used at any CDC-qualified lab. FDA said several other diagnostic developers are pursuing emergency use authorization.
By Maria Rachal • Feb. 05, 2020
HHS defends forcing hospitals to reveal negotiated rates

The agency took a jab at industry in its rebuttal to hospitals' legal challenge: "If patients pay less for healthcare, however, someone else receives less. Therein lies the genesis of this suit."
By Samantha Liss • Feb. 05, 2020
HHS partners with Regeneron on coronavirus drug development

The agency previously worked with Regeneron on the development and testing of an experimental Ebola treatment that proved effective in the 2018 outbreak of that disease.
By Ned Pagliarulo • Feb. 04, 2020
Hospitals spent $2.5B on social determinant programs from 2017 to 2019

The amount health systems are putting into SDOH initiatives is dwarfed by $60 billion in community benefit spending, but it's nevertheless a "substantial investment," Health Affairs researchers note.
By Shannon Muchmore • Feb. 04, 2020
Payers, providers urge CMS to scrap rule targeting supplemental Medicaid payments

The AHA warned the rule would "severely curtail the availability of health care services to millions" of people and cut Medicaid payments to hospitals by up to $31 billion annually.
By Samantha Liss • Feb. 03, 2020
CMS exchange rules for 2021 target premium subsidies

The agency is also seeking comments on a proposal requiring low-income exchange enrollees who pay no premiums to revisit the exchange during open enrollment to assert they're entitled to the same subsidy the following year.
By Ron Shinkman • Feb. 03, 2020
Payers, employers protest price transparency rule as wrong-headed

Most of the 23,355 public comments expressed skepticism or all-out opposition to the Trump administration's proposal targeting insurers.
By Samantha Liss • Jan. 31, 2020
The Trump administration is offering Medicaid block grants. Which states will say yes?

So far, the governors of Oklahoma and Arkansas have both expressed explicit support for the guidance allowing states to cap payments for adults who became eligible for Medicaid under the 2010 ACA expansion.
By Rebecca Pifer • Jan. 30, 2020
Codes for social determinants rarely used, analysis finds

The most frequently used code was for homelessness, followed by problems related to living alone and disappearance and death of a family member, according to CMS.
By Shannon Muchmore • Jan. 30, 2020
Trump admin to allow Medicaid caps, but legal fight likely as providers protest

Providers were quick to attack the highly anticipated plan giving states the option of accepting block grants for payment in the safety-net program, choosing between a per-enrollee or total coverage budget.
By Rebecca Pifer • UPDATED: Jan. 30, 2020 at 2:35 p.m.
Privacy versus access debate rages on, rekindled by Epic lobbying

Promoting interoperability without clear guardrails could lead to healthcare's version of Cambridge Analytica, Epic wrote in a public statement coinciding with ONC's annual health IT conference.
By Rebecca Pifer • Jan. 29, 2020
Backing for unique patient identifier picks up steam at ONC conference

The current ban on funding UPIs is "misguided policy," Rep. Bill Foster, D-Ill., said Monday at the gathering of IT and industry officials. But other experts warned it's "not a panacea."
By Rebecca Pifer • Jan. 28, 2020