Government: Page 123
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UnitedHealth sees growing interest in ACOs
The nation's largest private payer expects ACOs will continue to grow over the next year as employers look for ways to cut costs and improve quality.
By Les Masterson • July 23, 2018 -
Non-physician providers improve practice bottom lines, MGMA says
The survey also found that operating costs for primary care practices rose 13% over the past five years.
By Les Masterson • July 23, 2018 -
State individual mandates would boost coverage, curb premiums
The Commonwealth Fund reported there would be more than 7 million fewer uninsured people in 2022 if all states implemented individual mandates.
By Les Masterson • July 23, 2018 -
Deep Dive
Health systems increasingly think small. At the micro level.
"It's intended to be the 'Honey, I Shrunk the Kids' version," one hospital executive quipped about the micro-campus goal.
By Les Masterson • July 23, 2018 -
Halting safe harbor rebates will hike premiums, Wall Street analysts say
PBMs wouldn't suffer much from the proposal, but would instead pass costs onto the government and beneficiaries.
By Les Masterson • July 23, 2018 -
Beth Israel-Lahey Health merger would sharply hike health costs, Mass. panel finds
The attorney general has also raised concerns about the proposed deal, which would result in one of the largest mergers in the state’s history.
By Meg Bryant • July 20, 2018 -
CMS re-opens Kentucky Medicaid work mandate comment period
The move comes after a federal judge rejected the agency's approval of a waiver for the state.
By Tony Abraham • July 20, 2018 -
Controversial Anthem ER policy under fire in lawmaker's report
Under its policy of denying payment for ER visits later determined not to be emergencies, the insurer denied 5.8% of claims in three states across a six-month stretch in 2017. On appeal, a majority of those were later overturned.
By Rebecca Pifer Parduhn • July 20, 2018 -
ACA risk adjustment fix reportedly in the works
An interim final rule that could reinstate the $10.4 billion in risk adjustment payments to insurers CMS suspended earlier this month is being considered by the Office of Management and Budget.
By Tony Abraham • July 20, 2018 -
Drug lobby ramps up jabs at PBMs with pitch to curb rebates
PhRMA wants PBMs to be compensated on a fee-for-service basis, rather than from a percentage cut of a drug's list price.
By Ned Pagliarulo • July 19, 2018 -
GAO finds most 340B hospitals are rural, critical access
While the amount of charity and uncompensated care was higher among general acute care hospitals, the report found critical access hospitals provided less uncompensated care than those not in the program.
By Tony Abraham • July 19, 2018 -
Hikma ramping up injectable opioid output for US hospitals
The American Medical Association declared drug shortages to be a national public health emergency last month, and the stream of opioids available to providers has continued to dry up.
By Rebecca Pifer Parduhn • July 19, 2018 -
Jacob Bell/Healthcare Dive
FDA seeks to make more drugs available over the counter
Drugs that could change to over-the-counter products — with additional labeling and education of consumers — include cholesterol-lowering meds and the opioid-overdose reversal drug naloxone.
By Barbara Boughton • July 19, 2018 -
ACA Medicaid pay boost didn't lure docs, JAMA study says
Possible reasons for this lack of interest were delayed payments, a finite timeframe and documentation requirements to qualify.
By Les Masterson • July 18, 2018 -
Nearly half of antibiotics inappropriate in urgent care, CDC study says
Incorrect prescribing was prevalent in other outpatient settings as well, including emergency departments, medical offices and retail clinics.
By Rebecca Pifer Parduhn • July 18, 2018 -
Calls to revamp physician self-referral law grow louder
Device makers, lab, imaging and hospital companies all back changes to the Stark law, arguing it impedes the move toward alternative payment and value-based care.
By Susan Kelly • July 18, 2018 -
Sponsored by Southern Cross University
The impact of mental health in the workplace
With rates of reported mental health issues on the rise, are there enough initiatives in place to tackle the problem?
July 17, 2018 -
Anthem sued by doc groups over ED policy
American College of Emergency Physicians President Paul Kivela called the policy dangerous in expecting patients to know the difference between minor or potentially life-threatening conditions.
By Les Masterson • July 17, 2018 -
AHA 340B lawsuit denied by federal appeals court
The hospital industry lost its legal challenge to the Trump administration's cuts to the 340B drug pricing program, with a three-judge panel ruling AHA failed to meet certain necessary "presentment" requirements.
By Tony Abraham • July 17, 2018 -
HHS kills clinical guidelines website, cites budget cuts
The National Guideline Clearinghouse, a 20-year-old archive of best medical practices, was shut down this week. On Tuesday, the nonprofit that maintained the site said it will keep a fee-based version to launch in the fall.
By Rebecca Pifer Parduhn • July 17, 2018 -
FDA approves first drug designed to treat smallpox
Siga Technologies developed TPOXX under a federal defense contract amid fears of bioterrorism post 9/11.
By Barbara Boughton • July 17, 2018 -
Major payers unlikely to see financial hit from risk-adjustment halt, Fitch says
But the decision to halt the payments is likely to destabilize the individual market, according to the ratings agency.
By Les Masterson • July 16, 2018 -
Docs shouldn't be held accountable for healthcare costs, NEJM survey finds
Industry experts say out-of-pocket costs are important to patients but there are multiple barriers to properly educating them about healthcare pricing.
By Les Masterson • July 16, 2018 -
HHS OIG cites flawed efforts to prevent fraud in Medicaid managed care
A new report found that not all managed care organizations use proactive data analysis or inform states when providers are suspected of abuse.
By Les Masterson • July 13, 2018 -
CMS pitches expanded telemed billing, fewer MIPS measures
A proposed payment rule includes streamlining coding and setting new payments for virtual check-ins and examinations of patient-submitted images. More unpopular is a requirement to meet 2015 EHR standards by next year.
By Tony Abraham • July 12, 2018
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