Government: Page 108
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1 in 7 patients get surprise bill after in-network hospital care, HCCI finds
Anesthesiologists had the highest percentage of out-of-network professional claims in an in-network hospitalization, followed by primary care and emergency services, according to the Health Care Cost Institute.
By Les Masterson • March 29, 2019 -
Revenue, outpatient volume rise in Advocate-Aurora's debut year
Home, physician and outpatient visits all rose for the newly merged company in 2018, and revenue increased 3.5%.
By Tony Abraham • March 29, 2019 -
Judge rules Trump AHP expansion unlawful 'end-run' around ACA
The decision included strong words condemning the rule allowing for easier creation and use of AHPs, calling the regulatory change a "magic trick" that allowed for "absurd results" undermining the intent of Congress.
By Shannon Muchmore • March 29, 2019 -
Wyden floats adding prescription drug comparison tool to EHRs
A preliminary outline from the top Democrat on the Senate Finance Committee lacks many specifics, such as potential ramifications on EHR usability or increased administrative burden on providers.
By Rebecca Pifer Parduhn • March 28, 2019 -
AHA doubles down against star ratings, asks CMS to pull
The hospital group said in a letter to CMS it remains concerned the program "is being compromised by a methodology that can lead to inaccurate, misleading comparisons of quality performance."
By Shannon Muchmore • Updated April 1, 2019 -
Trump admin appeals ruling against Medicaid work mandates in Arkansas, Kentucky
A federal judge argued the programs are directly opposed to the "core objective" of Medicaid: to provide care to those in need.
By Tony Abraham • Updated April 11, 2019 -
Killing ACA would lead to huge spikes in uncompensated care
Medicaid expansion states and those with large ACA plan enrollment would feel the most pain if the landmark law is repealed.
By Les Masterson • March 27, 2019 -
VA seeks billions more for controversial community care program
Secretary Robert Wilkie this week asked for a funding increase of $4.6 billion in 2020 for the department's community care program, which critics contend is a means to privatize VA medical care.
By Tony Abraham • March 27, 2019 -
Industry urges slower pace on HHS interoperability rules
Officials from LifePoint, Omada Health and an IT group told a Senate panel more time is needed to process the rules and for implementation.
By Rebecca Pifer Parduhn • March 27, 2019 -
CMS, physician group launch AI challenge
The Artificial Intelligence Health Outcomes Challenge offers up to $1.65 million in awards. Developers will be tasked with building AI programs on Medicare data to improve health outcomes.
By Tony Abraham • March 27, 2019 -
Trump admin now backs elimination of ACA in court
The move came hours after Democratic attorneys general defending the ACA filed their brief arguing that the landmark law is still constitutional even without an effective individual mandate penalty.
By Shannon Muchmore • Updated March 26, 2019 -
Payer participation in ACA exchanges lacks in parts of US
In the Northeast, 40% of the population lives in an area with at least five ACA plan payers. That figure is only 4% in the South, according to the Urban Institute.
By Les Masterson • March 22, 2019 -
GAO finds 'small number' of payers dominate private, ACA markets
The three largest payers in most states owned 80% or more of the private market in 2016, with even more concentration in state ACA exchanges up to 2017, the watchdog agency said.
By Tony Abraham • March 22, 2019 -
MIPS participation in year 1 nets 95% of eligible clinicians
Of those participating in the Merit-based Incentive Payment System in 2017, 93% earned a positive payment adjustment, according to a new CMS report.
By Meg Bryant • March 21, 2019 -
Most health apps share data with third, fourth parties, BMJ analysis warns
"Clinicians should be conscious of privacy risks in their own use of apps and, when recommending apps, explain the potential for loss of privacy as part of informed consent," the study authors wrote.
By Meg Bryant • March 21, 2019 -
Several states in CMMI model made 'significant strides' in pop health integration
A new report on the progress of the State Innovation Model found participating states focused on value-based payments, along with integrating behavioral, physical and population health.
By Les Masterson • March 21, 2019 -
Sage's postpartum depression drug is approved. Now comes the hard part
Zulresso's label requires women to undergo a 60-hour infusion and only in certain settings, factors that may hamper the drug commercially.
By Jacob Bell • Updated March 20, 2019 -
Big changes to substance abuse privacy rule coming, sparking renewed debate
Some providers argue Part 2 is redundant and overreaching. HHS Deputy Secretary Eric Hargan called the rule "onerous" last week and hinted a rework is coming soon.
By Shannon Muchmore • March 20, 2019 -
Payers, employers pitch fixed reimbursement rates for out-of-network providers to curb surprise billing
Hospital groups quickly slammed the proposal as "a dangerous precedent" that could "create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks."
By Les Masterson • March 19, 2019 -
Physician-led ACOs leaving Medicare program in greater numbers
The vast majority of ACOs have stayed with the Medicare Shared Savings Program, however, with only 13% of them dropping out last year.
By Les Masterson • March 18, 2019 -
Direct enrollment for ACA plans may lead to higher costs, fewer protections
The Center on Budget and Policy Priorities warned that direct enrollment through entities other than HealthCare.gov or state exchange websites stifles competition and can confuse and mislead consumers.
By Les Masterson • March 18, 2019 -
Medicare, Medicaid advisory commissions alarmed by DSH cuts
The latest reports to Congress from the payment advisory commissions call for a sweeping redesign of quality measurement programs and signal concern for the financial viability of disproportionate share hospitals.
By Tony Abraham • March 18, 2019 -
Short-term plans, Medicaid waivers, MA benefits dominate AHIP conferences
A House panel is investigating short-term "junk plans" and payers look to take advantage of more flexible benefit options in Medicare Advantage. That (and more) from AHIP's dual conferences last week.
By Shannon Muchmore , Rebecca Pifer Parduhn • March 18, 2019 -
Medicaid work requirements will hurt hospital finances
Meanwhile, this week Trump administration officials argued in defense of the work requirements in front a skeptical federal judge who already halted the regulation in Kentucky.
By Les Masterson • March 15, 2019 -
Telehealth underused by federally qualified health centers, analysis finds
Centers use telehealth largely for behavioral health sessions with patients, though some store-and-forward activities and remote patient monitoring also occur, according to the report by RAND Corporation.
By Meg Bryant • March 14, 2019
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