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?
Medicaid beneficiaries deserve the same access to healthcare services and products as people with commercial insurance or Medicare. But since Medicaid pays doctors and hospitals 27 to 65 percent less than commercial health plans, it makes it awfully difficult for providers to be payer agnostic.
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."
Business has a vital concern in the financing of healthcare. So why is there not an outcry to switch to a proven financing system that would serve their employees well?
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.