Government: Page 106
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More Medicaid insurers could be ticket to lowering premiums in ACA markets
An Urban Institute and Robert Wood Johnson Foundation report shows a correlation between states with lower premiums and broad Medicaid managed care coverage within the state.
By Meg Bryant • April 30, 2019 -
Alex Wong via Getty Images
HHS curbs fines for HIPAA violations
A new legal interpretation of the act would cut the annual ceiling for a fine from $1.5 million and move to a tiered system, depending on violation severity.
By Rebecca Pifer Parduhn • April 29, 2019 -
Deductibles soar in small business health insurance market
Small companies are turning to plans with restricted provider networks as a way to contain healthcare costs, insurance broker eHealth found.
By Les Masterson • April 29, 2019 -
ACA could cushion payers during next recession: Moody's
While health insurers wouldn't be able to avoid taking a hit from lower employment levels, the rating agency's research shows Medicaid expansions and the ACA exchanges create protections the companies didn't have in 2008.
By Tony Abraham • April 26, 2019 -
FTC accuses Surescripts of monopolizing e-prescribing markets
The commission alleges the health IT vendor, owned by some of the biggest PBMs and pharmacies, used exclusivity agreements and threats to stop customers from using other platforms.
By Shannon Muchmore • April 25, 2019 -
CMS urges state Medicaid programs to test new dual eligible care models
The agency lamented the lack of care coordination for the dual eligible population that leads to "misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all."
By Les Masterson • April 25, 2019 -
Hospitals, doctors and Gawande laud new CMS primary care model, but will practices stay?
The agency set an ambitious goal of enrolling a quarter of all traditional Medicare fee-for-service providers and beneficiaries in the new model. The program, however, is voluntary, and some paths carry significant downside risk.
By Shannon Muchmore • April 24, 2019 -
Medicare proposes raising CAR-T pay, but reimbursement solution years away
As new technologies nip at CAR-T's heels, CMS could take three years to develop a separate reimbursement category for Novartis' Kymriah and Gilead's Yescarta.
By Jonathan Gardner • April 24, 2019 -
Half of middle-income seniors won't be able to afford healthcare, housing in a decade
Over the next decade, 60% of seniors will have mobility limitations and 20% will have high healthcare needs, according to a new study published in Health Affairs. And that's just the tip of the iceberg.
By Rebecca Pifer Parduhn • April 24, 2019 -
CMS proposes wage index change to help prop up rural hospitals
The agency's proposed inpatient payment system rule would boost hospital Medicare payments by about 3.7%, which Jefferies noted was the largest increase in a decade.
By Tony Abraham • April 24, 2019 -
Graying doctors, patients to fuel 122K physician shortage by 2032, AAMC warns
The Association of American Medical Colleges also notes that healthcare delivery trends such as better care coordination, value-based contracting and more advanced practice providers will cut demand for physicians by only 1%.
By Les Masterson • April 24, 2019 -
Data breach at physician staffing firm EmCare hits 31K patients
Unauthorized email access exposed patient, employee and contractor personal information, such as name, date of birth or age and patient clinical data, the company said.
By Les Masterson • April 23, 2019 -
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
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