CMS plans trio of experiments aimed at lowering drug costs

The pilot programs could allow adjusted payments for drugs cleared under accelerated approval and help states manage the costs of gene therapies.

By Christopher Newman • Feb. 15, 2023

Senator blasts Ascension, alleging it runs like private equity fund rather than nonprofit health system

Sen. Tammy Baldwin, D-Wis., said the system “appears to be evaluating each staffing decision, service line, and hospital location as solely a business decision while seeking to bolster cash to put towards its investment funds.”

By Hailey Mensik • Feb. 15, 2023

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Labor

Hospitals are navigating persistent labor shortages with the need to cut costs — a source of contention that could leave patients caught in the middle.

By Healthcare Dive staff

Surgical procedures cost significantly more at hospitals in networks versus independent facilities, study finds

The median price for a shoulder arthroscopy was $4,432 at hospitals within a network, compared to $2,643 at independent hospitals, new research in JAMA Network Open found.

By Hailey Mensik • Feb. 14, 2023

ONC debuts first cohort of qualified networks in TEFCA, including Epic, eHealth Exchange

Epic, CommonWell Health Alliance, eHealth Exchange, Health Gorilla, Kno2 and Konza — which collectively cover a significant swath of American health records — have committed to go live within TEFCA in 12 months.

By Rebecca Pifer • Feb. 14, 2023

FTC’s enforcement action against GoodRx unveiled a new regulatory threat. Should digital health apps be concerned?

The order suggests the regulator is willing to use every tool in its tookit to tamp down on sensitive data sharing as medical care turns increasingly online.

By Rebecca Pifer • Feb. 13, 2023

HHS pauses surprise billing arbitration after Texas court decision

The process by which health insurers and medical providers hash out payments for surprise bills is still in flux due to a series of lawsuits threatening the dispute resolution process.

By Rebecca Pifer • Feb. 13, 2023

Medicare to collect drug price rebates starting in 2025

The CMS has laid out how it plans to implement a key provision of the Inflation Reduction Act requiring drugmakers to pay rebates on price hikes in Medicare that are greater than inflation.

By Christopher Newman • Feb. 10, 2023

HHS readies for PHE wind down, end of pandemic flexibilities

A variety of pandemic-era policies will expire May 11, including those allowing providers to prescribe controlled substances via telehealth without an in-person visit and rules requiring payers to cover COVID-19 testing.

By Hailey Mensik • Feb. 10, 2023

Biden zeroes in on drug costs during State of the Union address

The president called for extending Medicare's $35 insulin price cap to all Americans and blasted “big pharma” for record profits while at the same time “unfairly charging people hundreds of dollars.”

By Shannon Muchmore • Feb. 8, 2023

MA enrollment grew 337% from 2006 through 2022, study finds

Traditional Medicare lost 1 million enrollees over the same period, according to new research published in Health Affairs.

By Hailey Mensik • Feb. 7, 2023

Major hospitals still noncompliant with price transparency rules

No hospitals in HCA Healthcare, Tenet, Providence and UPMC systems were fully compliant with federal price transparency rules, according to a new analysis.

By Hailey Mensik • Feb. 6, 2023

CMS issues 2% MA rate hike for 2024

Trade association AHIP said it was “concerned with the potential adverse impact of the rate notice,” especially in light of other recent regulation seeking to claw back overpayments to MA payers.

By Shannon Muchmore • Feb. 2, 2023

Texas Medical Association files fourth suit challenging surprise billing ban

The latest lawsuit focuses on boosted fees that both parties must pay for arbitration to solve billing disputes between providers and payers.

By Hailey Mensik • Feb. 1, 2023

FTC orders GoodRx to stop sharing users’ health data with advertisers, issues $1.5M fine

Officials said they’re putting the market on watch with the enforcement against the company, which allegedly collected and shared user data without consent. GoodRx denied all wrongdoing, and said it agreed to the fine to avoid litigation.

By Rebecca Pifer • Updated Feb. 1, 2023

CMS to crack down on Medicare Advantage audits, poised to claw back billions of dollars from insurers

Federal regulators have raised concerns about alleged payment abuses in the MA program for years, specifically for those tied to risk adjustments. 

By Samantha Liss • Jan. 31, 2023

Insurance lobby blasts Medicare Advantage audit rule

The America’s Health Insurance Plans lobby said the rule seeking to claw back billions of dollars from health insurers is unlawful and fatally flawed. 

By Samantha Liss • Jan. 31, 2023

COVID-19 public health emergency slated to end in May

The Biden administration warned that hospitals are at risk of revenue losses and care delays if the public health emergency ends abruptly.

By Samantha Liss • Jan. 31, 2023

Court rules for drugmakers over HHS in 340B fight over contract pharmacies

The decision is a win for drug manufacturers Sanofi, Novo Nordisk and AstraZeneca. The companies sued the HHS after regulators ordered them to stop restricting sales of 340B drugs to contract pharmacies.

By Rebecca Pifer • Jan. 31, 2023

Biden admin moves to undo moral opt-out to ACA contraceptive mandate

The rule also would create an option allowing people enrolled in health coverage or plans provided by “objecting entities” to obtain contraceptive coverage.

By Ryan Golden • Updated Jan. 30, 2023

Minnesota attorney general asks Sanford-Fairview to delay merger

“It’s more important to do this right than to do it fast,” Minnesota’s Chief Deputy Attorney General John Keller said regarding the deal. 

By Samantha Liss • Jan. 30, 2023

Louisiana sends cease-and-desist order to Express Scripts over delayed insurance claims

State officials began investigating Express Scripts in April after receiving multiple complaints from an independent pharmacy association over the Cigna-owned PBM’s handling of claims.

By Rebecca Pifer • Updated Jan. 31, 2023

Record-breaking 16.3M people signed up for ACA coverage

The 2023 enrollment numbers reflect a broader policy push from the Biden administration to increase insurance coverage, especially during the pandemic.

By Sydney Halleman • Jan. 25, 2023

More states propose nurse staffing, ratio laws

Lawmakers in three states are considering legislation around healthcare worker staffing and nurse-to-patient ratios after the pandemic caused the industry to suffer major workforce challenges.

By Hailey Mensik • Jan. 24, 2023

US to jack up fees for big mergers

Filing fees are expected to soar this year and companies, including those in healthcare, will need to prepare for increased regulatory scrutiny of M&A deals.

By Alexei Alexis • Jan. 23, 2023

Nonprofit hospitals may evade noncompete ban enforcement, experts say

Ambiguity remains over whether the ban would apply to nonprofit systems, which make up about half of all U.S hospitals.

By Samantha Liss • Jan. 20, 2023