FTC takes aim at state-shielded rural monopolies

The agency will study certificates of public advantage in three states — Tennessee, Virginia and West Virginia — that immunized certain health system mergers from federal antitrust scrutiny.

By Samantha Liss • Oct. 22, 2019

Drug distributors, Teva settle in Ohio opioid case: reports

The four companies, which include AmerisourceBergen, McKesson and Cardinal Health, will reportedly pay $260 million to two Ohio counties to avoid a trial. 

By Jonathan Gardner • Oct. 21, 2019

'Medicare for All' likely to keep private payers, but erode margins: Moody's

Several recent reports game out the costs and benefits of Democratic 2020 presidential hopefuls' healthcare proposals.

By Ron Shinkman • Oct. 18, 2019

Health IT advisory group targets price transparency, data security with eye toward 2020

HITAC members floated the idea of establishing a workgroup focused solely on price transparency, with one panel member calling it an area of "high interest, especially for consumers."

By Rebecca Pifer Parduhn • Oct. 17, 2019

Key committee pitches adding UDIs to insurance claim forms, called 'huge step'

If a unique device identifier is captured when a high-risk product is implanted, providers will be able to detect complications more quickly, said Joe Drozda, the director of outcomes research at Mercy Health.

By David Lim • Oct. 16, 2019

Sutter settles antitrust case, terms unknown

The agreement, reached just as the landmark trial was set to begin, is expected to be finalized in February or March. 

By Dana Elfin • Updated Oct. 18, 2019

Overwhelming majority of providers loathe prior authorization requirements, survey shows

HHS is attempting to address the issue, proposing a rule in June to update electronic prior authorization requirements in Medicare Part D plans. The head of ONC has also called for an overhaul of the process.

By Shannon Muchmore • Oct. 16, 2019

Medicare, Medicaid hospital payment cuts to hit $252.6B, industry study finds

"Hospitals are nearing the tipping point we have predicted for so long," Chip Kahn, CEO of the Federation of American Hospitals, said of the report commissioned by his group and AHA.

By Linda Wilson • Oct. 16, 2019

Pelosi plan would cut Medicare drug spending by $370B, CBO says

The proposal to require direct price negotiation between the federal government and the pharmaceutical sector stands little chance of quick action, but drugmakers are on defense nonetheless.

By Jonathan Gardner • Oct. 15, 2019

California bill to end excessive dialysis profits becomes law

Fresenius said it's concerned the new law will result in patients only being able to access care at hospitals due to lack of insurance coverage.

By Susan Kelly • Oct. 15, 2019

Oscar files appeal in battle with Florida Blue over exclusive broker policies

A federal judge ruled against the startup last month, despite the U.S. Department of Justice arguing the case should not be tossed.

By Samantha Liss • Oct. 15, 2019

Hospitals, manufacturers could donate cybersecurity software under proposed regs

With the cost of protecting systems from malicious hackers increasing, the idea to tweak the anti-kickback laws recognizes some physician practices don't have the resources or expertise to keep pace, one lawyer said.

By David Lim • Oct. 14, 2019

CMS issues 2020 star ratings for Medicare Advantage plans; Kaiser dominates

Centene and WellCare did not fare so well as the two attempt to wrap up their merger, a finding one analyst called "less-than-inspiring."

By Ron Shinkman • Oct. 14, 2019

Premier joins forces with Amphastar on 7 drugs in short supply

The agreement is another example of how healthcare companies are searching for new ways to address drug shortages.

By Kristin Jensen • Oct. 11, 2019

Appeals court judges skeptical of Medicaid work rule aims

During oral arguments in D.C. on Friday, a three-judge panel pressed for answers on why beneficiaries were losing coverage under the new requirements.

By Samantha Liss • Oct. 11, 2019

For COPD patients with high deductibles, more trouble getting care

Authors of the study said plans that "raise out-of-pocket costs or give individuals more 'skin in the game' could harm patients."

By Shannon Muchmore • Oct. 10, 2019

Providers mostly cheer anti-kickback revamp but some still wary

The Medical Group Management Association said the proposals fall short, citing a need for clarity on imaging, physical therapy and laboratory services as well as an overhaul of penalties.

By Samantha Liss • Oct. 10, 2019

Fresenius to pay $5.2M to settle Medicare overbilling allegations

DOJ alleged the company overbilled Medicare for more than seven years by ordering hepatitis B tests for patients it knew to be immune to the virus.

By Nick Paul Taylor • Oct. 10, 2019

With new report, ICER puts itself at center of drug pricing storm

Pharma price hikes added billions of dollars to U.S. spending in 2017 and 2018. For seven top drugs, the watchdog found those increases came with little new clinical evidence in support.

By Ned Pagliarulo • Updated Oct. 8, 2019

HHS pitches sweeping revamp of Anti-Kickback Statute, Stark Law

The department proposed several new safe harbors to encourage value-based care, allow patient engagement through furnishing of tools and supports and permit certain remuneration in some CMS-sponsored models.

By David Lim • Oct. 9, 2019

Colorado's public option plan cuts provider rates to lower premiums

The state hospital association immediately slammed the proposal as akin to government rate-setting with "the potential to significantly damage the health insurance market in our state."

By Rebecca Pifer Parduhn • Oct. 9, 2019

Former FDA chief Gottlieb predicts Trump-pitched pricing model easy to game

"I don't want to give too much away, because I'll tell people how to game around this," said the former commissioner, who now sits on Pfizer's board of directors.

By Andrew Dunn • Oct. 9, 2019

As docs ditch primary care to become hospitalists, MedPAC warns of shortage

The number of hospitalists increased nearly 50% between 2010 and 2017 while the number of PCPs is basically flatlining, according to a new report from the Medicare advisory commission.

By Ron Shinkman • Oct. 7, 2019

Waste gobbles up 25% of US healthcare spending, JAMA study finds

In accompanying editorials, former CMS officials lamented that many initiatives aimed at cutting unnecessary spending haven't been that successful and blamed the political landscape.

By Dana Elfin • Oct. 7, 2019

Healthcare leads the way as US hits lowest unemployment mark in decades

"[T]he combination of strong demand growth from healthcare employers and shortages of many clinicians (nurses, physicians) creates a positive set-up for the healthcare temp staffing industry," Jefferies analysts wrote.

By Shannon Muchmore • Oct. 7, 2019