Policy and Legislation
Ugly stories about waiting lists and poor care in VA facilities are coming out in the press. But in truth, there is not enough information to say whether the VA system is worse or better than the private system as a whole, or even to compare the VA with individual private sector hospitals.
States' taxing of Medicaid managed care organizations to raise revenue for state-share Medicaid payments may be illegal, according to the HHS Inspector General. If so, this raises serious questions that could shake up MCO financing models.
The Federal Trade Commission's blocking of hospital and physician practice mergers, as a way to purportedly prevent monopolies, is hurting the very people the FTC claims to be helping -- the patients themselves.
One of the biggest beneficiaries of healthcare reform's expansion of insurance coverage to more than 13 million people this year has been the nation's safety-net hospitals. At least in the states that have chosen to accept the Medicaid expansion.
The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled, sowing animosity between health systems and the feds.
With millions of Americans on new health insurance exchange plans now responsible for high deductibles, hospitals, drug makers, insurers and regulators are entering a new frontier of payment disputes.
CMS has just released a proposed rule that would require Medicare prior authorization for certain Medicare Durable Medical Equipment items that the agency characterizes as "frequently subject to unnecessary utilization." The decisions would not be subject to appeal.
Medicare may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing the controversial two-midnight rule that tells hospitals when patients should be admitted, according to an independent Medicare auditing company.
If global spending becomes the norm in Medicaid, health systems, medical practices, home health and community organizations will face an even greater impetus to collaborate. In the Empire State, some are already starting the journey.
Powerful social forces will drive the healthcare industry to innovate, overcoming institutional and political inertia, says healthcare consultant and futurist Ian Morrison. But things may not get 'serious' until 2018.