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Healthcare News

 

Study highlights long wait times in Canada under single-payer system. Does that make it a bad idea for U.S.?

12/11/2018


(FierceHealthcare)
The idea of a single-payer health system has been gaining ground among the general U.S. population and among doctors.


However, a new study focused on the long wait times that Canadians face between the time they see a primary care doctor and can get an appointment with a specialist for follow-up. Canada has had a single-payer system since 1984.


Opponents to a single-payer system say that’s a big reason why the U.S. should not move toward such a system, which has now largely been dubbed “Medicare-for-all.”


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Insurer-backed coalition forms to push efforts to stem 'surprise bills'

12/10/2018


(FierceHealthcare)
With the problem of surprise medical bills garnering growing national scrutiny, a group of insurance, business and consumer groups announced they've banded together to push for stronger patient protections.


Led by the likes of America's Health Insurance Plans, the National Business Group on Health and the Consumers Union, the new coalition is seeking legislative remedies such as requiring that patients be informed when care is out of network and know the cost of their treatment and options.


Other organizations in the nine-member coalition include the American Benefits Council, the Blue Cross Blue Shield Association, the ERISA Industry Committee, Families USA, the National Association of Health Underwriters and the National Retail Federation.


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CMS finalizes risk adjustment rule for benefit year 2018

12/10/2018


(FierceHealthcare)
The Centers for Medicare & Medicaid Services (CMS) finalized its risk adjustment rule for the 2018 benefit year on Friday, its latest step in a string of legal battles dating back to earlier this year.


The rule calculates the payment amounts using the average premium within a state, rather than the premium for each plan. CMS justified this approach by assuming the program must be budget-neutral based on certain provisions in the Affordable Care Act.


“Today’s final rule continues our commitment to provide certainty regarding this important program, to give insurers the confidence they need to continue participating in the markets, and, ultimately, to guarantee that consumers have access to better coverage options,” said CMS Administrator Seema Verma in a press release.


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AHIP says public charge rule will have ‘serious negative consequences’

12/10/2018


(FierceHealthcare)
The industry’s foremost health insurance lobby is pushing back against the Trump administration’s proposed “public charge” rule that it says could have huge economic consequences.


In comments submitted to the Department of Homeland Security, America’s Health Insurance Plans (AHIP) said it has “serious concerns” about the rule that would consider whether someone applying for permanent residency is likely to enroll in public programs like Medicaid, Medicare Part D and the Children’s Health Insurance Program (CHIP).


The group said the rule would lead to poorer health outcomes, shifting the cost of that care to all Americans. The proposed rule flies in the face of the Department of Health and Human Services’ stated goal of encouraging a healthy population.


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New Medicare Reimbursement for Lab Tests May Overpay by Billions

12/6/2018


(Revenue Cycle Intelligence)
- A new Medicare reimbursement system for clinical laboratory tests could increase spending for the public healthcare program by over $11 billion by 2020, a new Government Accountability Office (GAO) report shows.


The federal watchdog found that Medicare’s new method for determining the payment rates for laboratory tests, which was supposed to reduce Medicare spending by $360 million in the first year, could actually boost expenditures.


Medicare started to revise how it pays for clinical laboratory tests four years ago under the direction of the Protecting Access to Medicare Act of 2014 (PAMA). The act required CMS to establish a national fee schedule for laboratory tests based on private payer data.


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Healthcare spending slows for 2nd consecutive year, remains at 18% of GDP

12/06/2018


(FierceHealthcare)
Healthcare spending in the United States decelerated once again in 2017 to a growth rate of 3.9%, nearly a full percentage point lower than in 2016, according to new statistics released by the federal government on Thursday.


It’s the second consecutive year that healthcare spending has slowed, stabilizing healthcare’s share of the nation’s gross domestic product at 17.9%. Healthcare spending totaled $3.5 trillion, or $10,739 per person, and grew at a slightly slower rate of the overall GDP.


The lower rate is attributed to slower growth in the use and intensity of services in hospitals, clinics and physician offices, which make up 63% of healthcare spending, according to data released by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) and published in Health Affairs.


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OIG fraud recoveries dropped $1.2B this year. That might not be a bad thing

12/06/2018


(FierceHealthcare)
The federal government brought in 30% less in fraud recoveries in 2018 than it did the previous year, thanks to far fewer large settlements.


But that could be a net benefit, according to the agency.


The Office of the Inspector General recovered $2.9 billion from fraud investigations during fiscal year 2018, according to a semiannual report (PDF) to Congress released this week. That’s a $1.2 billion decline from last year, when the agency pulled in $4.13 billion.


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Medicare Advantage provider directories are riddled with errors. They're not the only ones

12/04/2018


(FierceHealthcare)
Medicare Advantage online provider directories are routinely filled with inaccuracies, according to a recently completed review by CMS.


With 48.7% of provider directory locations containing at least one inaccuracy, the directories have become unreliable. Like many patients, MA enrollees use provider directories to find providers who are in-network. But out-of-date or inaccurate information can leave patients scrambling.


Although the percentage of directories with at least one inaccuracy has declined slightly from last year, inaccurate directories have been a nagging problem for years. At times, directories said providers were at a different location than they really were. In some cases, they shouldn't have been in the directory at all.


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AHA, AAMC sue Trump administration over site-neutral payment rule

12/04/2018


(FierceHealthcare)
Two of the nation's largest healthcare groups are suing the Trump administration over a final rule to institute site-neutral payments for clinic visits, saying the policy would hurt patients.


Last month, the Centers for Medicare & Medicaid Services (CMS) finalized the 2019 Outpatient Prospective Payment System (OPPS) rule (PDF), which will gradually institute site-neutral payments in the Medicare program over the next two years. Agency officials said site-neutral payments for clinic visits will lower out-of-pocket costs for beneficiaries and save the program as much as $380 million in 2019.


In a complaint filed in the U.S. District Court for the District of Columbia, the American Hospital Association (AHA) and the Association of American Medical Colleges (AAMC) said the rule would lead to access problems as hospitals cut services, hurting vulnerable patients.


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Study: Telehealth can cut down in-person visits in the short term. Its long-term benefits remain murky

12/03/2018


(FierceHealthcare)
Telemedicine presents a viable way for providers to cut down on unneeded in-person visits and reach patients in more remote areas.


But their impact over time appears to drop off, raising questions about their long-term benefits, according to a new study.


Researchers followed Massachusetts General Physicians Organization’s rollout of a telemedicine program under Partners HealthCare’s accountable care organization, tracking data on 35,000 patients from between 2014 and 2017. They found that virtual visits decreased in-person visits by 33% over the course of the first year and a half.


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