MedPAC pushes for MIPS repeal

Members of the commission said MIPS is too complex and won't achieve the goal of improving patient care.

By Les Masterson • Oct. 9, 2017

Specialists risk wide swing in payments under MIPS proposal, Avalere says

Rheumatologists, oncologists and ophthalmologists are among specialists who bill for more Part B drugs, which could be included in calculating MIPS adjustments for performance year 2018.

By Meg Bryant • Oct. 6, 2017

Explore the Trendline➔

Payer/provider relationships

As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.

By Healthcare Dive staff

Skyrocketing out-of-pocket spending outpaces wage growth

The average deductible for people with employer-based health insurance increased from $303 in 2006 to $1,505 in 2017.

By Les Masterson • Oct. 6, 2017

AHA says OIG compliance reviews are fundamentally flawed

The hospital group said serious problems in the federal government review process result in grossly overstated repayment demands, harm hospital reputations and sap time and resources from patient care.

By Meg Bryant • Oct. 6, 2017

Many Medicare Advantage members have narrow provider networks

A Kaiser Family Foundation study found that Medicare Advantage physician network size varies greatly.  

By Les Masterson • Oct. 5, 2017

CHIP reauthorization moves forward, but slowly

Bills to finance the Children's Health Insurance Program passed in both House and Senate committees Wednesday, but there are disagreements over exactly how to pay for the program going forward.

By Les Masterson • Oct. 5, 2017

Cleveland Clinic, Humana launch co-branded Medicare Advantage plans

The partnership is the latest in a string of hospitals and health systems working with payers on insurance products. 

By Les Masterson • Oct. 3, 2017

Why providers should choose their MACRA tools wisely

“This is not a year-by-year, check-the-box program that you can wash clean year after year,” says Tom Lee, CEO of health IT firm SA Ignite.

By Meg Bryant • Oct. 3, 2017

Study: Unnecessary health spending fueled by low-cost, low-value services

Authors of the new report suggest reducing these services would not be as “politically charged” as reducing the more high-profile services that are of lower value.  

By Les Masterson • Oct. 3, 2017

With Price out at HHS, talk turns to replacement candidates

Names being circulated include FDA Commissioner Scott Gottlieb, Veterans Affairs Secretary David Shulkin and CMS Administrator Seema Verma.

By Shannon Muchmore • Oct. 2, 2017

Report: For-profit hospitals hurt by regulations, cost-cutting pressures

Fitch Ratings said federal and state regulations are creating an "unpredictable operating environment" around for-profit hospitals.

By Les Masterson • Oct. 2, 2017

Medicare Advantage will have more enrollment, lower premiums in 2018

The CMS expects slightly more than one-third of Medicare enrollees will have an MA plan next year.

By Les Masterson • Oct. 2, 2017

Anthem executive taking over top role at Optima Health

Dennis Matheis led the proposed Anthem-Cigna merger and oversaw Anthem's central region and the ACA exchanges.  

By Les Masterson • Oct. 2, 2017

Congress misses deadline to reauthorize CHIP

Lawmakers are set to discuss reauthorization this week, but at least three states would run out of CHIP funding by the end of this year if Congress fails to take action.

By Les Masterson • Oct. 2, 2017

Molina ex-CEO buying payer's California primary care clinics

Mario Molina, who was ousted in May, is purchasing 17 clinics serving about 120,000 patients.

By Meg Bryant • Sept. 29, 2017

Tenet Medicaid kickback scheme draws new charges

The case alleges improper referrals of pregnant women to Tenet hospitals. 

By Meg Bryant • Sept. 29, 2017

Report recommends CSR funding, resinsurance programs to stabilize ACA exchange market

For a more long-term solution, the study from the Urban Institute recommends slowing the market to reduce consumer premium and out-of-pocket costs as well as payer risk.

By Shannon Muchmore • Sept. 28, 2017

Aetna CEO advocates improving health at the community level

The payer's foundation helped launch a program last year that rewards small and mid-sized communities seed money to develop evidence-based strategies for improving measurable health outcomes.

By Shannon Muchmore • Sept. 28, 2017

ZoomCare's largest investor sues healthcare startup

Endeavour Capital invested $61 million in the insolvent company and now wants it placed in receivership.

By Jeff Byers , Les Masterson • Sept. 28, 2017

All US counties seem to have at least one ACA plan option

Payers had until Wednesday to sign federal agreements to offer ACA plans in 2018.  

By Les Masterson • Sept. 28, 2017

Out-of-pocket healthcare costs straining Americans' finances

People are delaying healthcare payments until they have enough money to pay their out-of-pocket medical costs. 

By Les Masterson • Sept. 27, 2017

Senator demands answers from Envision about surprise billing

U.S. Sen. Claire McCaskill (D-Mo.) sent a letter to Envision Healthcare asking questions about its subsidiary EmCare, one of the country’s largest physician-staffing companies for ERs, and the practice of surprise billing. 

By Les Masterson • Sept. 26, 2017

No vote for Graham-Cassidy ACA repeal bill

Congress has another looming healthcare deadline, as authorization for the Children's Health Insurance Program ends this week.

By Shannon Muchmore • Sept. 26, 2017

Another blow to Graham-Cassidy leaves repeal effort nearly dead

Maine Sen. Susan Collins said she would not support the proposal because of Medicaid cuts, weakened protections for people with pre-existing conditions and opposition from the healthcare industry.

By Shannon Muchmore • Sept. 26, 2017

Most Medicare members say they aren't getting recommendations about chronic conditions

More than 40% of survey respondents said their health plan never communicates with them at all about their condition.

By Les Masterson • Sept. 26, 2017