Policy & Regulation
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DOJ takes up lawsuit accusing Sutter Health of cheating Medicare
The whistleblower lawsuit alleges the California health system and an affiliate manipulated diagnosis codes to inflate payments.
By Meg Bryant • Dec. 13, 2018
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ACO trade groups says Medicare program saved $859M in 2016
The program, which includes 561 accountable care organizations and 10.5 million patients, saved more than $660 million between 2013 and 2016 after bonuses paid to providers for meeting spending and quality targets.
By Les Masterson • Dec. 13, 2018
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PwC: 'New Health Economy' finding its feet, but challenges remain
Providers are embracing digital treatments, with 77% saying they have suggested an app or digital program to a patient, according to the industry trends report.
By Meg Bryant • Dec. 12, 2018
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1 in 5 patients at high risk of socioeconomic health problem, survey finds
Patients who discuss their social determinant of health challenges with a clinician are more likely to accept help, according to the study. Younger patients, while twice as likely to discuss, are less receptive to assistance.
By Tony Abraham • Dec. 12, 2018
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4.2M Americans eligible for free ACA coverage, KFF says
In Iowa, Nebraska, Delaware and Utah alone, roughly half of potential marketplace shoppers could get a 2019 bronze plan with a $0 premium, according to the analysis.
By Rebecca Pifer • Dec. 12, 2018
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Lawmakers impatient for ONC interoperability rule
"It is hard to explain to people that Congress provided the tools necessary for doctors and patients to better coordinate their care through the sharing of patient data, but nothing has changed," Rep. Michael Burgess, R-Texas, said at a House health subcommittee hearing.
By Rebecca Pifer • Dec. 11, 2018
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Payer, hospital groups trade blame on surprise billing
The problem of patients unexpectedly getting a bill for out-of-network services is common and growing, especially for people getting emergency room care.
By Les Masterson • Dec. 11, 2018
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Middle-income Americans paying more for health insurance
Americans in the South are hardest hit — spending a bigger share of their income on healthcare than other parts of the country.
By Les Masterson • Dec. 10, 2018
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CMS reinstates risk adjustment program for ACA exchanges
In February, a federal judge in New Mexico vacated the risk adjustment program, namely the statewide average premium in the HHS methodology.
By Les Masterson • Dec. 10, 2018
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Deep DiveHospital labor skirmishes — year in review
The year was marked by heated negotiations over staffing and wages. Here's a month-by-month breakdown of how it went down.
By Tony Abraham • Dec. 10, 2018
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VA invests in medical messaging system, brings services to Walmart
The country's second-largest government agency has also reportedly been in talks with Apple on a deal that would see the tech giant build software for veterans to access their EHRs via their mobile devices.
By Tony Abraham • Dec. 10, 2018
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MedPAC pitches 2% boost in hospital Medicare payments, merged quality incentive program
The adviser to CMS and Congress on Medicare has been focused on the shift to value-based care in recent months. Its new linked proposals are no exception.
By Rebecca Pifer • Dec. 07, 2018
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Hospitals speak out against Trump proposed 'public charge' immigration rule
NYC Health + Hospitals said the system could lose up to $362 million the first year following the change. The AHA and the National Association of Community Health Centers have also criticized the plan.
By Les Masterson • Dec. 07, 2018
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National health spending slowed for 2nd straight year, at $3.5T
The spending growth rate, which fell to 3.9% in 2017 from 4.6% in 2016, was primarily held back by slowdowns in use of goods and services, with fewer people insured and getting care.
By Tony Abraham • Dec. 07, 2018
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Lack of provider competition raising healthcare prices, Center for American Progress argues
The left-leaning think tank offered suggestions for creating a system that produces more competition with fairer prices, including more regulatory enforcement and site neutral payments.
By Les Masterson • Dec. 06, 2018
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Hospital docs weigh in on CAR-T reimbursement: 'It's very complicated'
Looming over clinical victories seen at the American Society of Hematology's annual conference was a problematic question: How exactly will health systems pay for these powerful yet pricey therapies?
By Jacob Bell • Dec. 06, 2018
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Low nurse staffing levels directly linked to higher patient mortality, study finds
BMJ researchers found that the hazard of death increased by 3% for every day a patient experienced nurse staffing levels below the ward mean.
By Tony Abraham • Dec. 06, 2018
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Bipartisan bill introduced in Senate to penalize pharma Medicaid gaming
The incoming leaders of the Senate Finance Committee want to set monetary penalties for drugmakers that misclassify products within Medicaid.
By Andrew Dunn • Dec. 06, 2018
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Trump's deregulatory health agenda chided at conservative forum
"Competition won't work in healthcare unless it's managed," Mark Hall, director of health law and policy at Wake Forest University, said at the American Enterprise Institute forum.
By Rebecca Pifer • Dec. 05, 2018
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AHA, AAMC sue over site neutrality rule
The hospital groups say the final rule is harmful to patients, "especially those with the most complex needs and those in vulnerable communities."
By Tony Abraham • Dec. 05, 2018
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Narrow networks remain common in ACA marketplace
HMOs remain the most typical type of plan in the market. Exclusive provider organizations are increasing, and will make up 19% of all available options in 2019.
By Les Masterson • Dec. 05, 2018
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Most in Hospital Value-Based Purchasing Program to get higher payments next year
The data suggest slight improvements in quality and value for the 2,800 hospitals that take part in the program, including better total performance scores. However, fewer facilities received incentive bonuses than last year.
By Tony Abraham • Dec. 04, 2018
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Telehealth uptake surprisingly low among physicians, AMA finds
Large and specialty practices are more likely to use telehealth, suggesting that implementation costs are a barrier, according to a new study in Health Affairs.
By Meg Bryant • Dec. 04, 2018
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Dive AwardsThe Healthcare Dive Awards for 2018
The awards recognize the healthcare industry's top disruptors and innovators. These executives and companies are transforming the industry and shaping the future.
By Healthcare Dive Team
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HHS accepting comments on performance measure changes
The National Quality Forum's Measure Applications Partnership will make recommendations for changes to programs like MIPS by Feb. 1.
By Les Masterson • Dec. 03, 2018