Policy & Regulation
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Surprise billing ban draft: Middle ground leaves few pleased
The bill backed by a bipartisan group of Senate and House leadership would require insurers pay at least the median in-network negotiated rate for the area market for out-of-network services and has an arbitration backstop.
By Shannon Muchmore • Dec. 10, 2019 -
Supreme Court to hear $12B ACA risk corridors case this week
The justices will consider the case Tuesday. Observers say the money will not be the ultimate thrust of the court's decision — it's whether the business sector will have trust in the federal government in current and future partnerships.
By Ron Shinkman • Dec. 09, 2019 -
New life in surprise billing ban as key lawmakers reach agreement
With little time left in the session, a bipartisan group of committee leaders said they had reached a deal, but industry groups are stuck in their lanes.
By Shannon Muchmore • Dec. 09, 2019 -
Biotech's Alzheimer's pitch polarizes scientists
Two large clinical trials testing Biogen's drug aducanumab in patients with less advanced disease looked negative after early analyses, leading the company to stop them before they finished.
By Jacob Bell • Dec. 09, 2019 -
Dive Awards
The Healthcare Dive Awards for 2019
From the Affordable Care Act lawsuit to CVS Health CEO Larry Merlo, these are the companies, executives and movements that shaped U.S. healthcare this year.
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Roche MRSA test wins FDA OK
The agency said the novel diagnostic technology can deliver results in as little as five hours, compared to the one- to two-day wait time with conventional methods.
By Nick Paul Taylor • Dec. 06, 2019 -
US healthcare spending growth rebounded last year, influenced by insurance tax
Hospital and physician and clinical services spending fell, but prices were up. CMS Administrator Seema Verma blamed provider consolidation and the "creation of monopolies."
By Shannon Muchmore • Dec. 05, 2019 -
More state laws back telehealth, but many stop short of mandates
While regulations have inhibited growth in the past, many states are warming up to the adoption of virtual services. That's a "sea change compared to a decade ago," Foley & Lardner lawyers said.
By Linda Wilson • Dec. 05, 2019 -
Medicare Advantage members rarely review or switch plans
A Kaiser Family Foundation analysis found that more than one in three Medicare beneficiaries reported difficulty comparing plan options and nearly half of those on Medicare said they rarely or never review their choices.
By Shannon Muchmore • Dec. 04, 2019 -
Disparities between care in rural, urban areas getting worse
"The game is rigged," Janice Probst, a professor at the University of South Carolina's Arnold School of Public Health, said. "If we don't change the game, we never win."
By Rebecca Pifer • Dec. 04, 2019 -
Deep DiveWill sky-high drug prices spur the US to use an obscure power over patents?
New cell therapies as well as gene-based treatments like Zolgensma benefited from NIH funding of early-stage research. Advocates say the time is now for the government to invoke its "march-in" rights.
By Jonathan Gardner • Dec. 04, 2019 -
Senators push CMS, commercial payers on bias in algorithms
The letters sent to UnitedHealth, Blue Cross Blue Shield, Cigna, Humana and Aetna flagged a study that found racial bias in a widely used algorithm for assessing healthcare needs.
By Susan Kelly • Dec. 04, 2019 -
Hospitals sue HHS, warning price transparency rule would chill competition, crash computers
An agency spokeswoman shot back that hospitals "should be ashamed that they aren't willing to provide American patients the cost of a service before they purchase it."
By Samantha Liss • Dec. 04, 2019 -
'Refusal to properly report' data breach spurs $2.175M fine for Sentara Hospitals
"When healthcare providers blatantly fail to report breaches as required by law, they should expect vigorous enforcement action," HHS Office of Civil Rights chief Roger Severino said.
By Ron Shinkman • Dec. 02, 2019 -
Fitch says 2020 healthcare environment bumpy but negotiable
The legal fate of the Affordable Care Act is one of several uncertainties, according to the report. Ongoing opioid litigation is another.
By Ron Shinkman • Nov. 27, 2019 -
US life expectancy down in recent years after increasing for decades
Researchers noted the decline comes despite the U.S. spending far more than other high-income countries on healthcare. Deficiencies in the system "could potentially explain increased mortality from some conditions," they wrote.
By Shannon Muchmore • Nov. 26, 2019 -
Mandatory CMS radiation oncology model goes on backburner
Originally, the agency was eyeing an implementation date as early as Jan. 1, but the new regulatory agenda lists July 2022 as a target date for the bundled payment model.
By David Lim • Nov. 26, 2019 -
AdvaMed lobbied EPA chief Wheeler on cancer report amid delay in ethylene oxide regs
Group purchasing organizations working with hospitals are already seeing the impacts of the closure of ethylene oxide sterilization facilities, said David Gillan, senior vice president of sourcing operations at Vizient.
By David Lim • Nov. 25, 2019 -
Medical devices bigger culprit in antibiotic-resistant infections than surgical procedures, CDC analysis shows
Antibiotic resistance was higher in hospital-associated infections linked to use of devices like central lines, ventilators and urinary catheters, according to data collected from more than 5,600 sites between 2015 and 2017.
By Susan Kelly • Nov. 25, 2019 -
Michigan focus of latest lawsuit over Medicaid work rules
It's the latest court protest of Medicaid work requirements in the nine states that obtained waivers. Most of the challenges have prevailed.
By Ron Shinkman • Nov. 25, 2019 -
Uncompensated care up significantly at US hospitals, led by Southeast
Smaller hospitals and those in states that did not expand Medicaid under the Affordable Care Act were most hit, according to a new survey.
By Ron Shinkman • Nov. 22, 2019 -
Trump FDA nominee Hahn advanced by Senate HELP Committee 18-5
Ranking Member Patty Murray said she would not support the nomination due to a lack of a commitment to back regulations to take flavored e-cigarettes that have not gone under FDA review off the market.
By David Lim • UPDATED: Dec. 3, 2019 at 11:30 a.m. -
Under fire, Google defends Ascension data sharing project
Since "Project Nightingale" came to light last week, debate has raged over health data privacy. The reply from former Geisinger CEO David Feinberg comes as lawmakers seek more information.
By Shannon Muchmore • Nov. 21, 2019 -
Kentucky hospital pays $10M to resolve false claims, kickback allegations
The deal comes days after Sutter Health agreed to pay $30 million to settle claims it paid a group of cardiovascular surgeons in exchange for patient referrals and $15 million for other kickback and Medicare billing allegations.
By Shannon Muchmore • Nov. 21, 2019 -
Medicare improper payment rate falling, but up in Medicaid, CHIP
For Medicare fee-for-service, the improper payment rate was at 7.25% last year, which CMS said is the lowest since 2010.
By Linda Wilson • Nov. 20, 2019
