Policy and Legislation

A Pennsylvania provider is suing a health insurance company for passing on its 2 percent reimbursement cut required by sequestration.

Although a May 2014 U.S. District Court ruling vacated HRSA's 340B orphan drug regulation, the agency has issued an interpretive rule affirming its policy on the orphan drug exemption. The pharma industry is up in arms, but what does it all mean?

If we can identify the "underlying path" of health spending, we can do a better job of predicting the future from a noisy history. This underlying path can also serve as the curve to be monitored for evidence of any "bend."

If we don't fundamentally change the way we pay for healthcare, we won't change the economic principles that continue to drive the rapid growth in healthcare spending. Let's pay physicians and hospitals based on the health problems their patients have.

Hospices can now lose Medicare payments if they don’t file cost reports, and yet, because there are no penalties for inaccurate reporting, there is little motivation to spend much time on them.

Medicare regulators are updating hospital outpatient and ambulatory surgery center payments for next year, and also outlining a potential remedy to private Medicare overpayments.

A quarter of the nation's hospitals in October will receive lower Medicare payments because their rates of patient complications are higher than their peers. Here is an explanation of the three measures Medicare is using to calculate the hospital-acquired conditions scores.

Many questions remain on how specific details of the Affordable Care Act will be resolved, but one significant trend is clear: the shift toward risk sharing among patients, providers and insurers is well underway.

A quarter of the nation's hospitals, those with the worst rates of hospital-acquired conditions, will lose 1 percent of every Medicare payment for a year starting in October. The sanctions, estimated to total $330 million over a year, kick in at a time when most infections measured in hospitals are on the decline, but still too common.

MedPAC is out with its 15th annual mid-year report, offering advice for Congress and the Department of Health and Human Services to improve and sustain the senior's health program as it enrolls millions of retiring baby boomers. Here's what hospitals need to know about the commission's latest thinking.