Senators take aim at surprise billing

A draft bill from a bipartisan group would ban balance billing and require that insurers, rather than patients, pay out-of-network providers at 125% of the average in-network rate. 

By Tony Abraham • Sept. 19, 2018

AHA, on defense, pitches 340B 'stewardship'

The principles amount to the industry's riposte to calls for increased oversight and transparency by watchdogs and lawmakers in both parties. 

By Rebecca Pifer Parduhn • Sept. 19, 2018

Medicare ACOs save more money with more time, Avalere says

The Medicare Shared Savings Program has been scrutinized recently as more performance data surface. After the initiative missed federal cost savings projections from 2013 to 2016, recent results have been more promising.

By Les Masterson • Sept. 19, 2018

HHS launching database of patient safety culture at ambulatory surgical centers

The decision comes as the centers are treating more patients — a trend being pushed by payers, including Medicare, that want to move care away from more expensive inpatient settings.

By Les Masterson • Sept. 18, 2018

CMS proposes streamlining some Medicare compliance rules

If finalized, the rule would remove the requirement that ambulatory surgical centers have a written transfer agreement with a hospital or that the center's physicians have admitting privileges at a nearby hospital.

By Tony Abraham • Sept. 18, 2018

NQF report focuses on rural-relevant quality measures

The National Quality Forum's Measure Applications Partnership workgroup looked for measures that are cross-cutting, resistant to low case volume and drive access to care.

By Meg Bryant • Sept. 18, 2018

Challenge to short-term plans joins chorus of ACA lawsuits

While the outcome of a lawsuit threatening the landmark law is pending in Texas, patient advocates in Washington, D.C., and the Maryland attorney general are suing to protect the act.

By Les Masterson • Sept. 17, 2018

Cigna-Express Scripts merger cleared by DOJ

Federal regulators said the deal "is unlikely to result in harm to competition or consumers." Eyes now turn to the proposed Aetna-CVS union.

By Samantha Liss • Sept. 17, 2018

Patient groups attack CVS use of ICER metrics, urge rethink

In an open letter, more than 90 organizations called on CVS to reconsider its decision to use ICER's drug value assessments for determining coverage.

By Andrew Dunn • Sept. 17, 2018

Patient attribution crucial part of value-based contracting, actuaries say

There are trade-offs between attribution methods that rely on retrospective reviews of fee-for-service claims and those that attribute patients in advance of performance periods, according to a Society of Actuaries report.

By Les Masterson • Sept. 17, 2018

Hospitals, telehealth providers prepare for Hurricane Florence

As with last year's Hurricanes Harvey and Irma, hospital operators in Florence's path could take a financial hit. HCA, Tenet, Community Health Systems and LifePoint Health could all see volumes dip.

By Meg Bryant • Sept. 14, 2018

Payer trade group highlights need for housing programs

Housing is one of the most complex social determinants of health, and insurers have partnered with other health organizations to invest in affordable real estate and expand case management services, according to AHIP.

By Les Masterson • Sept. 14, 2018

When ICE comes knocking, healthcare workers want to be prepared

Hospital staff are on the front lines in the fight against a growing threat to their patients' health: fear.

By Tony Abraham • Sept. 14, 2018

Managed care companies, providers would benefit from Medicaid expansion

Four states with ballot initiatives this fall to expand Medicaid could boost bottom lines of big-name payers and health systems, according to a new report.

By Les Masterson • Sept. 12, 2018

California law brings more scrutiny of payer mergers

Payers must get approval from the state for any transaction that affects a "significant number of enrollees," "involves a material amount of assets" or adversely affects "the stability of the health care delivery system."

By Les Masterson • Sept. 12, 2018

Michigan threatens to repeal Medicaid expansion if work requirements not approved

Two JAMA studies bolster critics of work requirements who say most Medicaid recipients who are able to work are already doing so, and tracking compliance will heap more administrative burden onto an already-taxed system.

By Rebecca Pifer Parduhn • Sept. 12, 2018

Hospitals sue to require drug pricing transparency in 340B

HHS delayed implementing the regulations for the fifth time in June and has signaled they will be rolled into the administration's larger plan to cut drug costs.

By Tony Abraham • Sept. 12, 2018

Walgreens to take over 185 Fred's pharmacies

The dissolution of Fred's pharmacy operations is quite a departure from the drugstore's ambitions a year ago.

By Daphne Howland • Sept. 11, 2018

Kaiser Permanente commits to being carbon neutral by 2020

The Oakland-based integrated system said its purchase of 180 megawatts of clean energy will make the company the largest purchaser of renewable energy in the U.S. healthcare sector.

By Les Masterson • Sept. 11, 2018

Calls for more transparency after Memorial Sloan controversy

Renowned breast cancer researcher José Baselga, also CMO at Memorial Sloan Kettering, accepted millions of dollars from companies but failed to reveal those payments in published research.

By Meg Bryant • Sept. 11, 2018

Physician wellness, quality of care go hand-in-hand, analysis finds

Health systems should factor in how burnout affects performance, care quality and safety outcomes as they conduct business and treat patients, the authors of the JAMA report said.

By Les Masterson • Sept. 10, 2018

Modest ACA plan premium changes expected for 2019

Following a year of concern about hefty rate increases and the possibility of some counties not having any ACA plan options, 2019 is shaping up to be a stable year for the exchanges.

By Les Masterson • Sept. 10, 2018

Montana co-op wins $5.3M CSR lawsuit

The judge ruled that the federal government didn't fulfill its obligation under the ACA when it stopped the cost-sharing reduction payments last year.

By Les Masterson • Sept. 7, 2018

Medicaid waivers put transport benefits on chopping block

A new study shows non-emergency medical transportation saves Medicaid more than $40 million per month for every 30,000 beneficiaries. But some states have the longstanding benefit in their sights.

By Tony Abraham • Sept. 7, 2018

Physician-led ACOs saw savings in Medicare program

Hospital-integrated ACOs, however, didn't have the same success, according to a study published in the New England Journal of Medicine.

By Les Masterson • Sept. 6, 2018