Government: Page 224
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Do insurers have unfair advantage over hospitals buying doctor practices?
What happens as hospitals and health insurers continue to acquire physician practices, and hospitals are held to a stricter legal standard on paying fair market value?
By Judy Packer-Tursman • June 16, 2014 -
OIG demands $9.8M Medicare refund extrapolated from few claims
The audit revealed that about half of an Ohio hospital's 228 claims under review were compliant. But the rest of the claims spelled big trouble — after auditors extrapolated the hospital's penalty into the millions.
By Judy Packer-Tursman • June 16, 2014 -
Explore the Trendline➔
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TrendlineSurprise Billing
Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.
By Healthcare Dive staff -
AMA telemedicine policy puts emphasis on in-person visits
The model policy is cautious in tone, calling for a "valid patient-physician relationship" in advance of any treatment via telemedicine.
By Katie Bo Williams • June 12, 2014 -
Medicare poorly tracks hospital infections
Hospital infections continue to pose both health risks and heavy financial costs. And tracking them, according to a new study, is "an imprecise science." Just how big is the impact of hospital complications?
By Judy Packer-Tursman • June 12, 2014 -
New payment models to surpass fee-for-service by 2020
The new study by McKesson suggests two-thirds of payments will be value-based in less than 10 years — which worries providers much more than payers.
By Judy Packer-Tursman • June 12, 2014 -
Provider coalition opposes competitor's acquisitions
Massachusett's largest health system wants to expand, and the state AG's office is obliging. But rival providers are crying foul and urging full public disclosure prior to the deal's final approval.
By Judy Packer-Tursman • June 12, 2014 -
HHS allows new delay for some SHOP exchanges
Small businesses 'employee choice' option on health plans will wait until 2015 in 18 states with federally facilitated SHOP exchanges. The implications for hospitals remain unclear.
By Judy Packer-Tursman • June 11, 2014 -
Mercy Health System to lay off 300 across four states
The hospital blames the layoffs on state-level refusal to expand Medicaid, indicating that even large systems are not immune to the impact of recalcitrant legislatures.
By Katie Bo Williams • June 10, 2014 -
Health systems, ACOs urge HHS to lift telehealth restrictions
Increasingly, health systems and ACOs are embracing telehealth as a way to extend care and improve efficiency. But they aren't clear whether federal regulators will heed stakeholders' urging to waive restrictions on it.
By Judy Packer-Tursman • June 10, 2014 -
AMA pushes for physician-led care models
Doctors want to take charge of health-care delivery, leading teams serving primary-care needs through value-based care models such as ACOs. Where does this leave hospitals in the fast-changing market?
By Judy Packer-Tursman • June 10, 2014 -
MD exchange reports proposals for double-digit 2015 premium hikes
...while other proposals call for premium decreases. Is Maryland's dominant insurer seeing sicker-than-average new members this year? Are other plans seeking lower rates just to compete or are their members healthier?
By Judy Packer-Tursman • June 10, 2014 -
Hospitals see surge of ER patients under reform
Medicaid expansion was intended shift the newly insured into primary care and away from the ER, but in some states, the opposite is happening. What factors are playing into this unexpected situation, and how can it be corrected?
By Judy Packer-Tursman • June 10, 2014 -
VA audit reveals 57,000 vets await appointments
But does the audit show the full extent of systemic problems? How much will VA's outlined emergency fixes actually help?
By Judy Packer-Tursman • June 9, 2014 -
Deep Dive
The Highmark Health gamble: How risky is insurer-hospital integration?
After purchasing a Pennsylvania health system, Highmark Health posted a $186 million loss in 2013 and may lose the leading area provider from its network. What happens next, and what does the Highmark story mean for the trend of vertical integration?
By Judy Packer-Tursman • June 9, 2014 -
It's time to get tougher on patient dumping
Massive fines haven't staunched a really ugly trend with dire consequences.
By Anne Zieger • June 9, 2014 -
Cleveland Clinic CEO Cosgrove says no to VA post
Why did the senior exec decide to stay put? Is it partly to remain in the driver's seat of a Ferrari instead of riding off in an old Rambler?
By Judy Packer-Tursman • June 7, 2014 -
Health care doubles average monthly job growth in May
Economic indicators point to a good start to 2014 for the hospital sector. Will the good news continue?
By Judy Packer-Tursman • June 6, 2014 -
Are hospitals that buy oncology practices grabbing extra profits?
A report says hospitals buying oncology practices have increased their purchases through a federal drug discount program meant for low income Americans — with almost half of such hospitals pocketing savings.
By Judy Packer-Tursman • June 6, 2014 -
Senate confirms Sylvia Burwell as next HHS secretary
Now, Burwell must determine how she wants to steer the organization before a new administration takes over in 2017 — and before the next open enrollment period in 2015.
By Katie Bo Williams • June 5, 2014 -
3M Medicaid applicants stuck in limbo
The Obama administration is boasting the success of Medicaid expansion under reform, but technical glitches and a surge of applications have woefully backlogged enrollment. How will this impact providers?
By Judy Packer-Tursman • June 5, 2014 -
Does the ONC have the authority to regulate health IT?
Republican lawmakers have asked National Coordinator for Health IT Karen Salvo to comment on the extent to which ONC is shifting its focus from coordinating and promoting health IT — to regulating it.
By Anne Zieger • June 5, 2014 -
AHA calls for halt of OIG compliance reviews
Are Office of Inspector General audits "redundant" to the Recovery Audit Contractor program? The AHA thinks so — and claims they are an unfair and expensive burden on hospitals.
By Judy Packer-Tursman • June 5, 2014 -
Are Medicare Advantage plans being overpaid by billions?
Another study says "yes," blaming unjustifiably high risk scoring for plan members — but the industry fires back. Is the increase in risk scores due to MA plans' aggressive billing or a sicker patient population?
By Judy Packer-Tursman • June 5, 2014 -
Medicaid expansion boosts some hospitals' revenue
And the numbers are striking. One hospital in Seattle expects to see an additional $20 million this year alone — double its initial projection.
By Judy Packer-Tursman • June 4, 2014 -
Medicare to cover hepatitis C screening, but not in the hospital
With 17,000 Americans infected annually, CMS wants to protect adults from the virus — if they go to the right care setting.
By Judy Packer-Tursman • June 4, 2014
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