Government: Page 104
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CMS details new primary care payment model with range of risk options
The agency projects as many as a quarter of traditional Medicare fee-for-service beneficiaries will be incorporated into the voluntary five-year program, called Primary Cares Initiative.
By Shannon Muchmore • April 23, 2019 -
Medicare spending to snowball to 6% of GDP in next 2 decades, trustees predict
It's "striking" how Congress has ignored the warning signs of runaway spending, Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy, told Healthcare Dive.
By Rebecca Pifer Parduhn • April 23, 2019 -
Surprise billing, drug rebates among likely reforms this year, S&P Global says
ACA repeal efforts and "Medicare for All," however, have little chance of advancing in the current political landscape, according to a new report.
By Meg Bryant • April 22, 2019 -
CMS makes no change to silver loading, finalizes lower ACA exchange fees
The final rule for 2020 exchange plans also allows insurers to forgo applying drug manufacturer coupons toward patient out-of-pocket cost limits when a brand name drug has a generic alternative available.
By Shannon Muchmore • April 22, 2019 -
Fewer uninsured ED visits, hospitalizations after ACA, JAMA study finds
The report also credited recent trends like new payment models for the decrease, as well as growing hospital ED alternatives such as urgent care clinics, freestanding emergency rooms and telemedicine.
By Les Masterson • April 22, 2019 -
Hospital-led generic drug company Civica Rx opens headquarters
The company's opening comes after criticism of drugmakers and pharmacy benefit managers for price increases and generic drug shortages.
By Les Masterson • April 22, 2019 -
Alex Wong via Getty Images
HHS drops 2nd TEFCA iteration, extends interoperability rules comment period
With three new TEFCA documents in addition to a facelift on the first draft, the government is narrowing a common set of data exchange principles for health IT providers and users to adopt.
By Rebecca Pifer Parduhn • April 22, 2019 -
VA snafus prompt bipartisan call for more EHR oversight
An unflattering status report, GAO criticism and the VA CIO's absence during a congressional hearing are just a few of the reasons senators want extra control over the project.
By Tony Abraham • April 18, 2019 -
NYC hospitals agree to hire 1.5K nurses, raise wages
Under the deal, nurse-to-patient staffing levels will be based on ratios agreed upon in the parties' contracts and "enforced by an independent neutral party."
By Tony Abraham • April 18, 2019 -
Safety net hospitals benefit from change to readmission reduction program
The rule, which took effect in fiscal year 2019, separated hospitals into five groups, each with similar proportions of dual eligible patients and adjusted payments for socioeconomic factors.
By Tony Abraham • April 17, 2019 -
Nearly all states using value-based payment models
Researchers commissioned by health IT firm Change Healthcare found 34 states have initiatives that are two years or older. Just four states have no official value program: Georgia, Indiana, Mississippi and West Virginia.
By Shannon Muchmore • April 16, 2019 -
Primary care accounts for small fraction of Medicare spending
Primary care spending percentages were lower for more vulnerable beneficiaries and varied by state, according to a new report by RAND.
By Les Masterson • April 16, 2019 -
Growing ED use in rural areas putting strain on safety nets, JAMA finds
Rural ED visit rates increased by more than 50% between 2005 and 2016, compared to only a slight increase for urban departments, according to the study.
By Les Masterson • April 15, 2019 -
Better quality, lower costs when providers and payers share risk
Integrated Healthcare Association's review of California care found that capitation is connected with better healthcare quality.
By Les Masterson • April 15, 2019 -
Safety net hospitals near 'breaking point,' advocacy group says
America's Essential Hospitals said safety net facilities saw their average margin cut in half in 2017.
By Les Masterson • April 12, 2019 -
Medicaid reimbursement, not expansion status, affects doctors' acceptance of new patients
The percentage of providers willing to take on new Medicaid patients also did not change based on a state's Medicaid managed care offerings, according to an analysis of MACPAC data.
By Les Masterson • April 11, 2019 -
Pharmacy's 'middlemen' counter pharma's campaign to shift the price blame
Banning rebates will not be a silver bullet leading to cost control, PBM executives argued in front of the Senate Finance Committee.
By Jonathan Gardner • April 9, 2019 -
Hospital execs argue disruptors will 'skim the cream,' ignore community health
CEOs of Henry Ford Health System and Yale New Haven Health worry new entrants in healthcare could divert revenue from hospitals, leaving them with unnegotiable Medicare and Medicaid payments.
By Tony Abraham • April 9, 2019 -
Hospitals, payers decry HHS proposal to change safe harbor for drug rebates
The comments come as chiefs at the big pharmacy benefit managers — UnitedHealthcare's Optum, Cigna's Express Scripts and CVS Caremark — take the hot seat before the Senate Finance Committee on Tuesday.
By Les Masterson • April 9, 2019 -
Emergency department visits rose, but misuse fell in 2016
Wait times improved, according to the CDC data. Nearly 40% of patients had wait times of less than 15 minutes and 72% waited less than an hour.
By Les Masterson • April 8, 2019 -
CMS gives MA plans telehealth boost with expanded benefits
Building on recently finalized policies to expand supplemental benefits, the rule also seeks to update star ratings methodology and improve the appeals process for dual eligible beneficiaries.
By Tony Abraham • April 8, 2019 -
340B program leads to higher costs, PhRMA-commissioned report finds
The research conducted by Berkeley Research Group is the latest skirmish in a battle over the program, which health systems argue helps safety net hospitals access affordable prescription drugs.
By Les Masterson • April 8, 2019 -
MedPAC wants to redesign MA quality bonus program
The advisory commission also voted Thursday to recommend Congress pass legislation to withhold some Medicare Advantage plan payments if an insurer's encounter data is wrong or incomplete.
By Rebecca Pifer Parduhn • April 5, 2019 -
3 issues that put VA officials on defense in front of Congress this week
VA Secretary Robert Wilkie and others argued in a series of hearings that the agency is prepared to roll out its community care program by the deadline two months from now and that its EHR implementation woes are improving.
By Tony Abraham • April 5, 2019 -
Bruce Bennett via Getty Images
CVS expands same-day Rx delivery to 6K stores
Increasing home delivery options could be a huge advantage for the drugstore retailer against rivals like Walgreens and even Amazon.
By Daphne Howland • April 5, 2019
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