Signups lag in first days of ACA open enrollment

It's still early in the process, but enrollment will need to pick up significantly over the next month to approach last year's numbers, according to CMS data.

By Les Masterson • Nov. 8, 2018

ACA, hospitals win as health focus helps Dems flip House

Democrats will be able to swat down any attempts at repealing the Affordable Care Act, but it's unlikely Congress will stitch together repair efforts for the ACA, either, analysts warn.

By Samantha Liss • Nov. 7, 2018

Red states say 'yes' to Medicaid

Three GOP-heavy states expanded Medicaid on Tuesday, and Democratic governor pickups could further the trend. Elsewhere on midterm ballots, nurse-to-patient staffing ratios lost and California hospitals scored a win.

By Rebecca Pifer Parduhn • Nov. 7, 2018

Earnings reveal pharma's mixed feelings on Trump drug pricing proposal

A plan that would shake up how CMS pays for Medicare Part B drugs could leave the bottom lines of major players like Roche, Amgen and Bristol-Myers exposed, according to analysts.​

By Jacob Bell • Nov. 7, 2018

5 election takeaways for pharma

Democrats took back the House on Tuesday, raising the prospect of more scrutiny on drug pricing. Experts, however, don't expect a major deal with President Trump.

By Ned Pagliarulo • Nov. 7, 2018

North Carolina proposes setting hospital payments for state employees on Medicare rates

Hospitals elsewhere are likely to watch the plan closely, worried it could set a precedent. The move comes as providers are pushing back against CMS price cut proposals and on the defensive against complaints about high costs.

By Meg Bryant • Nov. 6, 2018

Land O'Lakes calls itself first to offer new association health plans

The Trump administration has encouraged AHPs to spur cheaper health insurance options, but critics call out flexibility for plans to offer skimpier protections.

By Les Masterson • Nov. 5, 2018

After provider uproar, CMS steps back from major E/M revamp

The agency's final Physician Fee Schedule rule for 2019 cuts E/M documentation requirements, pushes controversial E/M coding changes to 2021, adds telehealth payments and lowers the amount CMS pays for new drugs.

By Tony Abraham • Nov. 2, 2018

Hospitals slammed with $380M in CMS cuts, industry cries foul

CMS says the changes will create a level playing field by cutting reimbursement for visits to hospital-owned outpatient facilities. AHA said it will bring legal action.

By Samantha Liss • Updated Nov. 2, 2018

Medicare Advantage audits could save $4.5 billion over a decade, CMS says

America’s Health Insurance Plans questions the audits and how they could affect health insurers and beneficiaries. 

By Les Masterson • Nov. 2, 2018

9 state healthcare battles to watch Tuesday

It's not just Congress up for grabs in today's midterm elections. From Medicaid expansion to dialysis treatments to nurse staffing ratios, here's a snapshot of key votes, the odds and what they could mean for the industry.

By David Lim , Tony Abraham , Rebecca Pifer Parduhn , Samantha Liss • Nov. 2, 2018

HHS proposes start date for 340B ceiling price after hospital pressure

After delaying the start date five times, the department has proposed enforcing ceilings for the drug pricing program beginning Jan. 1. Hospital groups that sued the agency applauded the move.

By Tony Abraham • Updated Nov. 1, 2018

23andMe wins FDA clearance for first-of-its-kind genetic test

The agency also sent a safety communication warning about the danger of relying on genetic tests that have not been reviewed by FDA making claims about patient response to individual medications.

By David Lim , Nick Paul Taylor • Nov. 1, 2018

AdvaMed pitches new Anti-Kickback Statute safe harbors

The trade group wants the carve-outs for value-based pricing, warranty and risk-sharing arrangements.

By David Lim • Oct. 31, 2018

MA plans could use more telehealth services under proposed rule

The proposal would also revise star ratings methodology and improve CMS efforts to recover improper payments.

By Les Masterson • Oct. 29, 2018

AMA expands tool to find underserved patients, help pop health efforts

The updated service will let providers pinpoint areas and populations that could "benefit most from their skills and services," the group's president said.

By Les Masterson • Oct. 29, 2018

ACA premiums would be lower if not for GOP efforts, report finds

Premiums in unsubsidized exchange plans will be 6% higher next year than if Congress and the White House didn't implement policy changes like zeroing out the individual mandate penalty, according the Kaiser Family Foundation.

By Les Masterson • Oct. 29, 2018

ONC: Nearly 9 in 10 hospitals updated to 2015 edition EHRs

More than 40% of acute care hospitals are performing in all four interoperability domains — send, receive, find and integrate.

By Meg Bryant • Oct. 29, 2018

Flu season is here. Health systems are bracing for it.

Despite last season's sobering numbers, two recent studies found that many Americans still aren't getting vaccinated.

By Les Masterson • Oct. 29, 2018

Novarad augmented reality system for surgery gets FDA nod

The OpenSight system is designed for use with Microsoft HoloLens technology.

By Meg Bryant • Oct. 25, 2018

Status quo or blue wave? How the midterms could hit healthcare companies

Election Day is here, and who voters send to Congress will have implications throughout the healthcare industry. Here's a reminder of the various scenarios.

By Samantha Liss • Oct. 25, 2018

Gottlieb 'extremely worried' on CAR-T reimbursement

The FDA head referenced how radiopharmaceuticals were treated in reimbursement, "underpaying hospitals and forcing them to lose money." He warned the same thing is happening now with CAR-T.

By Andrew Dunn • Oct. 25, 2018

Trump pitches new plan to bring US drug prices down

The administration's latest effort will take aim at Medicare Part B, looking to link drug payments in the U.S. to the prices pharmaceutical companies set abroad. 

By Ned Pagliarulo , David Lim • Oct. 25, 2018

Healthcare prices lowest in Baltimore, highest in San Jose in 2016, report shows

Variation in costs can be related to, among other factors, differences in price levels and growth of service categories such as inpatient, outpatient and professional services, according to the Health Care Cost Institute.

By Tony Abraham • Oct. 25, 2018

Trump signs opioids bill as GAO says government can do more

Also this week, CMS rolled out a payment model to improve care coordination for mothers with opioid use disorders.

By Meg Bryant • Oct. 25, 2018