Government: Page 103
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ACOs may need stronger financial incentives, like downside risk, to succeed
The proportion of ACOs taking downside risk has inched up in recent years but still represents a minority, a study published in Health Affairs found.
By Rebecca Pifer Parduhn • July 3, 2019 -
Air ambulance charges soar over most other providers
A new study in Health Affairs examines the price air ambulances charge Medicare, an important figure that reveals the potential financial exposure some patients may face if they receive a surprise, out-of-network bill.
By Samantha Liss • July 1, 2019 -
Hospitals saved $1K per episode under joint replacement bundled model
Most participating hospitals received reconciliation payments in at least one of the program's first two years. Those getting the bonus tended to have higher quality scores, more episodes of care and lower patient complexity.
By Shannon Muchmore • July 1, 2019 -
Deep Dive
Once 'bodies for hire,' CROs are finding a new role as data specialists
Drugmakers and regulators are paying more attention to what real-world data can prove — driving demand for contract research providers to help keep up.
By Jacob Bell • June 28, 2019 -
Hospital groups argue CMS wage index proposal flawed
Providers generally approve of the attempt to prop up rural hospitals with a change to the wage index but most don't agree with the redistribution method the agency suggested earlier this year.
By Shannon Muchmore • June 27, 2019 -
Aiming for price transparency, Civica Rx hits snag with bundled payments
The payment model, often opaque on specific drug costs, affects many of the medicines the hospital-led group is targeting, according to commercial chief Heather Wall.
By Jacob Bell • June 27, 2019 -
CMS clears Louisiana Medicaid 'Netflix model' for hep C drugs
The subscription model will go into effect Monday, coming after the state inked a five-year partnership with a Gilead subsidiary to manufacture the treatment.
By Rebecca Pifer Parduhn • June 26, 2019 -
Left-leaning think tank highlights 'high price of hospital care'
Acute care hospitals had total margins of nearly 8% in 2016, the highest in more than a decade and above profits for pharmacies, payers and pharmacy benefit managers, according to the Center for American Progress.
By Shannon Muchmore • June 26, 2019 -
Deep Dive
Hospital price transparency push draws industry ire, but effects likely limited
While few would argue for secrecy for its own sake, policy analysts say there's little evidence patients use the information now available to make decisions that could bend the cost curve.
By Shannon Muchmore • June 25, 2019 -
Supreme Court to hear $12B risk corridor case next term
The Chamber of Commerce urged the court to take the case, warning that if the government is allowed to renege on its promised payments it could scare off the business community from working with the government.
By Dana Elfin • June 25, 2019 -
Trump order to force hospitals to reveal information behind negotiated rates
Providers and payers will be required to give patients estimates for out-of-pockets costs for procedures in advance under an executive order the president is expected to sign Monday. A legal challenge is likely.
By Shannon Muchmore • June 24, 2019 -
Surprise billing fixes would ding hospitals, staffing companies, Moody's says
Legislative proposals to end the practice of surprise billing are mostly credit negative for providers, but fixes that include bundled billing or an in-network guarantee would have the worst effect.
By Rebecca Pifer Parduhn • June 21, 2019 -
Deep Dive
Industry interoperability concerns plague TEFCA draft
ONC's "on-ramp" to nationwide connectivity is being dogged by many of the same issues as its interoperability regulations, including implementation, standardization and privacy.
By Rebecca Pifer Parduhn • June 20, 2019 -
UnitedHealth's acquisition of DaVita physician group gets FTC approval
Under an agreement reached with the federal agency, the payer will divest the medical group's Las Vegas practice to Intermountain Healthcare.
By Shannon Muchmore • June 20, 2019 -
Public option, increased premium credits could save $12B
Such changes would also provide coverage for an additional 1.2 million people, according to a report from the Urban Institute.
By Shannon Muchmore • June 19, 2019 -
CMS proposes rule to set Part D electronic prior authorization standards
Under the standard, providers can use an electronic prescribing system or EHRs to determine whether a plan requires prior authorization for the medication being prescribed and submit the information in real time.
By Shannon Muchmore • June 18, 2019 -
Senators differ on best approach to ban surprise billing
Senate HELP Committee Chairman Lamar Alexander, R-Tenn., seemed to support a guarantee that any care received at an in-network facility would be covered by a patient's insurer, a measure opposed by the provider lobby.
By Rebecca Pifer Parduhn • Updated June 19, 2019 -
MedPAC urges MA data, primary care reforms
Included in the recommendations to Congress are changes to slow the growth of ER spending in Medicare fee-for-service.
By Samantha Liss • June 14, 2019 -
House votes to overturn decades-old ban on national patient identifier
Industry cheered the first step in repealing the 23-year-old ban, with NextGate CTO Dan Cidon saying it will "move the needle" on interoperability.
By Rebecca Pifer Parduhn • June 14, 2019 -
CMS warned Trump policies would hike taxes, cause ACA disruption, internal memo says
Democratic leaders on the House Energy and Commerce Committee sent a letter Friday to HHS Secretary Alex Azar inquiring into the harmful effects of administration policies in light of what they called "damning" evidence.
By Rebecca Pifer Parduhn • June 14, 2019 -
Yujin Kim/Healthcare Dive
FDA taps IBM, Walmart for blockchain pilot project
Merck and KPMG will also be part of the initiative, which aims to track medicines and ensure their integrity across the supply chain.
By Kristin Jensen • June 13, 2019 -
Payers, providers dig in on surprise billing proposals
Industry groups are testifying on the issue before Congress again Wednesday at the third hearing in as many months.
By Shannon Muchmore • June 12, 2019 -
AMA affirms opposition to single-payer in close vote
Other proposals the physician group adopted encourage a focus on vulnerable patients in alternative payment models, more scrutiny on pharmacy benefit managers' role in the drug supply chain and tweaks to the Affordable Care Act.
By Shannon Muchmore • June 12, 2019 -
Congress warns industry to hurry on surprise billing fix
"If you don't solve the problem, then we will solve the problem and none of you will like it," Rep. Michael Burgess, R-Texas, told payer and provider reps testifying Wednesday.
By Rebecca Pifer Parduhn • June 12, 2019 -
Industry balks at Senate proposals to boost competition, price transparency
Employers and health policy experts argued banning certain contract clauses and making more information available to consumers would benefit patients in comments to the Senate HELP committee this week.
By Shannon Muchmore • June 7, 2019
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