Government: Page 101
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Surprise bills surge in ER, inpatient settings, JAMA finds
The study comes as lawmakers prepare to debate legislation tackling the problem, including a Senate bill that sets a payment standard for out-of-network services. Providers are pushing back.
By Shannon Muchmore • Aug. 12, 2019 -
Sponsored by Optum
Part 1: The US has fantastic health care, the problem is….
CEO Dr. Wyatt Decker discusses his perspectives on the challenges and opportunities for reinventing health care.
Aug. 12, 2019 -
Lack of tech, not jobs, could ding Medicaid enrollees facing work requirements
A large proportion of enrollees in the 16 states attempting to impose work requirements on Medicaid beneficiaries already have jobs or are providing care for someone in their household, according to the Kaiser Family Foundation.
By Ron Shinkman • Aug. 12, 2019 -
North Carolina folds to provider pressure with insurance plan shifting away from set rates
The new hybrid network will consist of more than 68,000 providers. The initial proposed State Health Plan network included only 28,000.
By Rebecca Pifer Parduhn • Aug. 9, 2019 -
Louisiana drops Aetna, Centene plans from 2020 Medicaid managed care contracts
The state public health department dropped the two vendors, which manage benefits for roughly a third of the state’s 1.7 million Medicaid enrollees.
By Ron Shinkman • Aug. 9, 2019 -
Q&A
California's AG on future of ACA suit, CVS-Aetna union
Xavier Becerra talked to Healthcare Dive about suing Sutter, J&J and what could be his most influential case yet: defending the Affordable Care Act.
By Dana Elfin • Aug. 8, 2019 -
Courtesy of Gilead Sciences
Medicare boosts CAR-T cancer therapies with expanded coverage
CMS also broadened the settings in which the pricey therapies would be covered, applying its final rule to use in "healthcare facilities" rather than explicitly in hospitals.
By Ned Pagliarulo • Aug. 8, 2019 -
California surprise billing law disrupted contract negotiations, stakeholders say
The 2017 law was also perceived to have driven further provider consolidation in response to the leverage shift, according to research published in The American Journal of Managed Care.
By Shannon Muchmore • Aug. 7, 2019 -
Few patients price shop before planned hospital visit, survey finds
As CMS and lawmakers push for price transparency, the survey from a revenue cycle management software vendor suggests consumers may not know how to evaluate different options based on price, or even be aware that prices vary.
By Linda Wilson • Aug. 7, 2019 -
Adeline Kon/Healthcare Dive
ColumnMyth Diagnosis: Do hospitals charge more to make up for low government pay?
"What is crystal clear is that there's a huge unit cost payment differential between government and commercial payers," John Pickering of Milliman said. "What isn't clear is whether there's a causal effect between those two."
By Shannon Muchmore • Aug. 7, 2019 -
CMS tweaks hospital wage index change in final rule
The agency is heeding some concerns from hospital groups that facilities in urban areas would be unfairly dinged in the original plan, but the American Hospital Association isn't entirely on board with the new method either.
By Shannon Muchmore • Aug. 2, 2019 -
Anthem again irks docs with latest changes to reimbursement
"It is a nuisance. It makes absolutely no sense," dermatologist George Hruza said of the policy denying payment for certain follow-up office visits the same day a procedure is performed.
By Samantha Liss • Aug. 2, 2019 -
White House backs importing drugs from abroad
The Trump administration's latest drug price plan features ideas Republicans traditionally oppose, and breaks with past claims about the FDA's ability to safely oversee importation.
By Jonathan Gardner • July 31, 2019 -
Teva, Endo among generics paying $70M in California pay-for-delay settlement
The state accused Teva, Endo and Japan-based Teikoku of anticompetitive practices on two drugs, which it said drove healthcare costs higher.
By Jacob Bell • July 30, 2019 -
CMS pilot to give docs direct access to Medicare claims data
The agency hopes to eventually roll out the initiative to all Medicare fee-for-service providers, giving doctors Medicare claims data for their patients, including prescribed medications, procedures, diagnoses and other providers.
By David Lim • July 30, 2019 -
Judge nixes New Hampshire's Medicaid work requirement
The ruling is the third time the judge has shot down such demonstration projects, having vacated similar plans in Arkansas and Kentucky on identical grounds.
By Dana Elfin • July 30, 2019 -
CMS proposes forcing hospitals to reveal negotiated rates
Insurer and hospital groups swiftly pushed back against a mandate to publish payer-specific rates for at least 300 services that patients can plan in advance. A legal challenge is likely.
By Samantha Liss • July 30, 2019 -
Sponsored by HMS
COB innovation: Identifying Medicaid 3rd party liability prior to the point of care
Improperly declaring Medicaid as the primary payer when other coverage exists is a seemingly small error that has widespread implications for the healthcare ecosystem.
July 30, 2019 -
Elizabeth Regan/Healthcare Dive
Mylan's tumble ends with Pfizer rescue
A deal marrying Mylan with Pfizer's off-patent drugs unit will help prop up the struggling generics maker now, but long-term growth remains in question.
By Jonathan Gardner • July 29, 2019 -
CMS will no longer approve full federal funding for partial Medicaid expansion
The policy pivot dashes the hopes of a handful of Republican states looking to receive more federal money for covering fewer people than states with full Medicaid expansion under the Affordable Care Act.
By Rebecca Pifer Parduhn • July 29, 2019 -
Hospital groups propose overhaul to patient satisfaction survey
The questionnaire "has a great track record, but it has not been closely looked at in more than a decade," said Federation of American Hospitals President Chip Kahn, adding hospital care has evolved in that time.
By Shannon Muchmore • July 25, 2019 -
OIG suggests closer look at impact of rule pushing risk on Medicare ACOs
In another recommendation on the Medicare Shared Savings Program, the watchdog suggested CMS adopt outcomes-based performance measures — rather than process measures — and standardize measures across programs.
By Linda Wilson • July 25, 2019 -
As HHS muses more MA flexibility, payers see roadblocks to nonmedical benefits
Implementation challenges, uncertain return on investment and a lack of clarity on what supplemental benefits are allowed are making some payers wary of offering nonmedical services in Medicare Advantage.
By Rebecca Pifer Parduhn • July 24, 2019 -
Senate committee targets Medicare drug price increases with bipartisan bill
Legislation proposed Tuesday would also reimburse physicians less for administering expensive intravenous drugs to beneficiaries.
By Jonathan Gardner • July 23, 2019 -
CMS' Verma blasts 'Medicare for All,' public option in rhetoric ramp up
The remarks were unusually strong for the CMS leader. Though she has often beat the party drum on plans conservatives call a dangerous step toward socialism, the breadth and specifics of her critique expanded.
By Rebecca Pifer Parduhn • July 23, 2019
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