Medicare Advantage quality bonus program hasn't improved quality, study finds

The new findings published in Health Affairs suggest the quality bonus program doesn't move the needle on quality despite a significant federal investment — hinting the American people may not be getting enough bang for their buck.

By Rebecca Pifer Parduhn • Dec. 8, 2021

States with robust merger reviews are tougher on hospital tie-ups, study suggests

Just eight states challenged the majority of the deals that regulators scrutinized during a 10-year time period. Still, it did little to slow price increases, according to new research in Health Affairs.

By Samantha Liss • Dec. 7, 2021

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Surprise 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

Congress passes on delay to Medicare rate cuts for lab tests, for now

The American Clinical Laboratory Association wants lawmakers to stave off Jan. 1 cuts for nearly 600 lab tests. A stopgap bill late last week did not include a reprieve, but Cowen analysts are optimistic a legislative fix will be found.

By Greg Slabodkin • Dec. 6, 2021

Appeals court limits nationwide halt on health worker vaccine mandates

A federal appeals court Wednesday stopped the nationwide pause on CMS' vaccine mandate, limiting the scope of that injunction to the 14 states that sued for relief.

By Hailey Mensik • Updated Dec. 16, 2021

Insurers now required to pay for at-home COVID-19 tests

Nearly 150 million insured Americans will benefit from the move, helping to lower their costs for the over-the-counter tests that can retail for around $25 for one kit.

By Samantha Liss • Dec. 2, 2021

VA to resume Cerner medical record implementation early next year with new leadership

Officials have released an updated deployment schedule for the beleaguered $16 billion EHR modernization project.

By Rebecca Pifer Parduhn • Dec. 2, 2021

FDA panel, after debate, narrowly backs Merck COVID pill

While agency advisers raised concerns over molnupiravir's modest benefits and potential risks, a majority felt the antiviral drug is a needed option for COVID-19 patients at high risk of severe disease.

By Jonathan Gardner • Updated Nov. 30, 2021

Hospital lobby argues its case against 340B payment cut before SCOTUS

Tuesday's arguments seemed to center around single words and phrases to determine whether HHS had the authority to change payment rules in 2018 for 340B hospitals, which serve a large share of low-income patients.

By Samantha Liss • Dec. 1, 2021

Hospital lobbying fails to stop looming Medicare cuts in year-end proposal

Lawmakers on Thursday reached a bipartisan year-end spending bill that doesn't include provisions to push back or stop the upcoming Medicare cuts.

By Rebecca Pifer Parduhn • Updated Dec. 3, 2021

Supreme Court to hear oral arguments in 340B case with billions of dollars at stake

A lower court initially sided with the American Hospital Association, a decision that was later reversed by an appeals court, which AHA characterized as a "legal error."

By Samantha Liss • Nov. 30, 2021

Healthcare worker vaccine mandate blocked nationwide in second ruling

A federal judge granted a preliminary injunction Tuesday in a suit brought by 14 states challenging the requirement, following separate pauses in other states.

By Hailey Mensik • Updated Dec. 1, 2021

Biden admin investing $1.5B to quell healthcare staffing shortages, promote workforce equity

The funding will go toward scholarship and loan repayment programs for healthcare students committing to work in hard-hit and high-risk communities, according to the White House.

By Hailey Mensik • Nov. 23, 2021

Anesthesiologists say Blue Cross NC 'abusing' surprise billing ban to drive down rates

Doctors are raising the alarm against what they perceive as Blue Cross NC's "take it or leave it" ultimatums to in-network clinicians, using the consumer protection legislation as a bargaining chip to negotiate more favorable rates.

By Rebecca Pifer Parduhn • Nov. 23, 2021

Ground ambulances, excluded from surprise billing ban, to get scrutiny from federal committee

Recommendations from the new federal advisory committee will help inform policy changes to improve how charges and fees for ground ambulance services are disclosed to consumers, CMS said.

By Hailey Mensik • Nov. 22, 2021

FDA, aiming to curb another COVID-19 surge, clears Pfizer, Moderna boosters for all adults

The decision comes as at least 10 states open up booster dose eligibility beyond the current, more limited authorizations while cases remain at high levels.

By Ben Fidler • Nov. 19, 2021

Biden admin proposes wide-reaching drug data collection in fourth surprise billing rule

Payers and employers will need to give HHS an annual overview of the top 50 drugs across different areas, including the most frequently dispensed drugs and the most expensive prescription drugs.

By Rebecca Pifer Parduhn • Nov. 18, 2021

MCIT breakthrough device payment pathway included in Cures 2.0 bill

Lawmakers on Tuesday introduced a revised MCIT proposal in the next version of the 21st Century Cures Act, following last week's repeal of the final rule by CMS. Industry groups AdvaMed and MDMA backed the legislation.

By Nick Paul Taylor • Nov. 18, 2021

30% of hospital healthcare workers remained unvaccinated as of September

Healthcare workers in children's hospitals had the highest vaccination rates, along with those working in metropolitan counties, according to the analysis of Centers for Disease Control and Prevention data.

By Hailey Mensik • Nov. 18, 2021

Pfizer asks FDA to authorize COVID-19 pill

Study results released earlier this month showed the pill, when given soon after symptoms start, dramatically reduced the risk of COVID-19 hospitalization or death.

By Ned Pagliarulo • Nov. 17, 2021

Congress, alongside provider and consumer groups, continues spat over surprise billing ban rules

While payers and providers must start complying with the No Surprises Act by Jan. 1, the fight over rules implementing the ban is heating up as provider groups object to what they think is a favoring of insurers.

By Hailey Mensik • Nov. 17, 2021

CMS guides hospitals on co-location of staff, services

The agency's final guidance on the practice of sharing resources in an effort to improve provider efficiency drew praise from the American Hospital Association.

By Susan Kelly • Nov. 17, 2021

As Congress weighs drug price restraints, ICER calls out 'unsupported' increases

In a new report, ICER highlighted AbbVie's price hikes on Humira, which the group said resulted in more than $1 billion in U.S. spending last year without any new evidence of health benefits.

By Jonathan Gardner • Nov. 16, 2021

Congress: Target the middlemen who drive up drug costs

"The PBM market lacks the three elements essential for competition — choice, transparency and a lack of conflict of interest," antitrust attorney and former FTC policy director David Balto argues.

By David Balto • Nov. 15, 2021

Biogen's pricey Alzheimer's drug contributes to major Medicare premium hikes

The 15% jump in Part B premiums for 2022 is a case study in how just one expensive medication can affect the spending of millions in the U.S.

By Rebecca Pifer Parduhn • Nov. 15, 2021

Zelis helps address new NSA and TiC regulations

Learn more about innovative solutions that can help you comply with new regulations.

Nov. 15, 2021