New CMS value-based payment model aimed at rural hospitals, ACOs

The program will include upfront and capitated payments for providers as well as some regulatory flexibilities. It will require facilities to partner with state Medicaid agencies in an attempt to improve care coordination.

By Shannon Muchmore • Aug. 11, 2020

State coronavirus testing plans diverge wildly, some intend slowdown by December

Monthly testing target reports submitted to HHS show Connecticut and Illinois seek to scale up, for example, while Louisiana and Maine predict lower volume by the end of the year.

By Maria Rachal • Aug. 11, 2020

OIG says hospitals overbilled Medicare $267M by improperly coding post-discharge services

The watchdog recommended CMS direct its recovery audit contractors to recoup overpayments made within the past four years.

By Ron Shinkman • Aug. 10, 2020

Telehealth claims dipped in May, but still up 5,680% from year ago: Fair Health

The latest insurance data found private claims for virtual care fell 33% from April, but are still wildly up amid lockdowns and the ongoing pandemic.

By Ron Shinkman • Aug. 7, 2020

Trump tries to revamp drug supply chain with latest order

A directive announced by the president Thursday would require government agencies to buy certain "essential" drugs from factories in the U.S. How easily such an order would be implemented isn't clear.

By Ben Fidler • Aug. 7, 2020

DOJ sues Cigna, alleging $1.4B in Medicare Advantage fraud

The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.

By Hailey Mensik • Aug. 6, 2020

Fresh off Medicaid win in Missouri, Fairness Project calls for health industry to step up

"We need to see health insurers and private hospitals step up and make massive investments in these campaigns," Jonathan Schleifer, executive director of the D.C.-based advocacy group, told Healthcare Dive.

By Samantha Liss • Aug. 6, 2020

Missouri voters usher in Medicaid expansion

It's the latest red state to take the issue of expanded access to government-sponsored health coverage to its voters, ringing in a victory via an amendment to the state's constitution. 

By Samantha Liss • Aug. 5, 2020

CMS proposes eliminating inpatient-only list

The agency said the COVID-19 pandemic has "highlighted the need for more healthcare access points throughout the country," including ambulatory surgical centers.

By Shannon Muchmore • Updated Aug. 4, 2020

CMS expands telehealth coverage in physician fee rule following Trump executive order

The agency proposed making permanent almost two dozen new telehealth codes. A notable exception is Medicare's temporary reimbursement for audio-only visits, though the agency did ask for public input on the omission.

By Rebecca Pifer Parduhn • Aug. 4, 2020

COVID-19 caused hospital ED visits to dive more than 40%

Researchers in JAMA examined trends at major providers such as Mount Sinai Health, Baystate Health and Yale-New Haven, also finding emergency patients were more likely to be admitted.

By Ron Shinkman • Aug. 3, 2020

Quarter of Medicare members can't access telehealth visits, JAMA studies show

The gallop to digital delivery of care may have left more marginalized populations without access to high-speed internet, a smartphone or even a computer behind, two studies suggest.

By Rebecca Pifer Parduhn • Aug. 3, 2020

House panel finds Trump admin bungled Philips ventilator deal, overpaid by $500M

Philips denied raising prices to benefit from the COVID-19 crisis and said it is on track with scheduled production and delivery of ventilators.

By Susan Kelly • Aug. 3, 2020

Hospitals consider Supreme Court appeal in 340B drug payment cut case

Judges have denied a request from the American Hospital Association and other plaintiffs to have the case reheard before the full bench after the nearly 30% rate reduction was upheld in July.

By Shannon Muchmore • Updated Oct. 20, 2020

US promises $2.1B to Sanofi, GSK in latest coronavirus vaccine deal

The contract is the largest yet from the Trump administration's Operation Warp Speed, although Sanofi and GSK have yet to begin clinical testing of their shot.

By Ned Pagliarulo • July 31, 2020

HHS prods Congress to act on surprise billing, but doesn't take a side on how

Congress has taken some action on surprise billing in the face of the coronavirus pandemic, barring the practice for COVID-19 testing and treatment during the public health emergency. Still, a larger overhaul is unlikely soon.

By Shannon Muchmore • July 29, 2020

Telehealth made up almost half of all Medicare beneficiaries' primary care use in April

Fee-for-service beneficiaries adopted telehealth for primary care at unprecedented rates as COVID-19 spread in the U.S., according to a new HHS report.

By Rebecca Pifer Parduhn • July 29, 2020

CMS to begin recouping COVID-19 Medicare loans

Hospital groups have pleaded with the Trump administration and Congress to forgive the loans, or relax repayment terms, with no relief so far.

By Rebecca Pifer Parduhn • July 27, 2020

After 6 months of darkness, primary care practices see little light ahead

"You have to dig yourself out of a financial hole — it's not a hole, it's a crater — created by the pandemic," said Gary LeRoy, president of the American Academy of Family Physicians.

By Rebecca Pifer Parduhn • July 27, 2020

What it's like to be a nurse after 6 months of COVID-19 response

"I think the biggest change is we always relied on science, and we have always relied heavily on infection control protocols to guide our practice," a nurse working on the frontlines said. "Now infection control is out of control, we can no longer rely on the information and resources we always have."

By Hailey Mensik • July 27, 2020

'Weeks where decades happen': Telehealth 6 months into COVID-19

The nascent industry exploded out of necessity earlier this year, but its future staying power will depend on what insurers are willing to cover and whether some of the regulations relaxed because of the pandemic will stay rolled back.

By Rebecca Pifer Parduhn • July 27, 2020

6 months in: Following the flow of CARES hospital funding

Congress has allocated $175 billion to help providers respond to the COVID-19 crisis, but HHS has been hit with multiple complaints about distribution as that money goes out the door.

By Samantha Liss • July 27, 2020

6 months in: What will the new normal look like for hospitals?

Whether there is a nationwide second wave or smaller surges in regions at different times, hospitals will need to remain vigilant and in an effective state of emergency until there is a cure or vaccine for COVID-19.

By Shannon Muchmore • July 27, 2020

6 months in: The COVID-19 crisis

This series of stories examines how healthcare has changed during the course of the novel coronavirus in the United States, half a year after HHS declared a national public health emergency.

July 27, 2020

Skinny short-term plans deny coverage for pre-existing conditions: Commonwealth Fund

The analysis of more than 400 plans called junk by critics concluded few offer tangible benefits. The Trump administration backs short-term plans, arguing they're a low-cost alternative to broader coverage.

By Ron Shinkman • July 23, 2020