Healthcare Finance Staff
The U.S. Supreme Court has ruled that state and local government-owned corporations are not always immune from federal antitrust laws, allowing the Federal Trade Commission (FTC) to continue its challenge of a merger by two health systems owned by a Georgia county hospital authority.
The Healthcare Group Purchasing Industry Initiative has released its seventh annual "Report to the Public," which finds that group purchasing organizations (GPOs) put the promotion of innovation and technology among their top priorities.
Robert Master, MD, has been trying to create a primary care model for poor, elderly and disabled patients in greater Boston since the late 1970s, and in 2003 he co-founded the not-for-profit Commonwealth Care Alliance, a delivery system for Medicaid-Medicare dual eligible, developmentally and physically disabled patients.
The Centers for Medicare & Medicaid Services (CMS) has proposed several dozen regulatory updates to Medicare Advantage and Part D prescription drug plans, covering cost sharing, minimum loss ratios, risk adjustment, payment methodologies and other policies.
After President Obama suggested reducing "taxpayer subsidies to prescription drug companies" as an avenue for Medicare savings in his State of the Union speech, the Pharmaceutical Research and Manufacturers of America trade group went on the offensive, saying it would "upend the successful Medicare Part D prescription drug program by imposing government price controls on it" and "harm Part D's competitive dynamics, yielding higher premiums."
At President Obama's State of the Union address, Oregon Governor John Kitzhaber, a guest of Michelle Obama, might have been hoping for a mention of Oregon's ambitious Medicaid reform program, an ACO-like financing and delivery redesign that may eventually extend to Medicare members, public-sector employees and even privately-insured residents.
As a result of the Affordable Care Act and the additional 30 million new customers who will be shopping for and buying insurance products starting in October, health insurance companies are trying to find ways to change their business model. Whereas insurers' focus for decade has been on B-to-B relationships, this new world of healthcare consumerism will make it necessary to become focused on a retail consumer market.
When Senator Marco Rubio (R) of Florida said in the Republican response to President Obama's State of the Union address that "the biggest obstacles to balancing the budget are programs where spending is already locked in," the first example he then turned toward is Medicare.
For many physician practices -- especially those working with health maintenance organizations (HMOs) -- obtaining pre-authorization to perform certain treatments or procedures is a necessary evil: Physicians must request pre-authorizations accurately and in a timely fashion or they won't get paid.
The Internal Revenue Service (IRS) declared employer-sponsored health insurance tax exempt in 1943, and ever since health benefits have been an integral part of the American workplace and the greater economy. Today, it is at a crossroads, amid health reform, economic and demographic trends.