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Healthcare News

 

Payers face higher rates due to provider billing fights, new survey finds

8/19/2019


(FierceHealthcare)
While billing is primarily believed to be a provider-payment issue, a new survey finds that complications are spilling over and affecting payers.


Patient billing collections has caused providers to negotiate for higher rates from insurers, according to a new survey conducted by HIMSS of providers and payers. The survey, sponsored by the billing management startup OODA Health, comes as Congress is pondering ways to tackle surprise billing.


The survey found 67% of the 39 hospitals and health systems queried use patient collections as a “justification for rate increases in payer negotiations, with 21% using it prominently,” according to a white paper on the results.


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Opposition to 'Medicare for All' remains, but the AMA drops out of coalition fighting single-payer system

8/16/2019


(FierceHealthcare)
While it continues to oppose “Medicare for All,” the American Medical Association (AMA) has dropped out of a coalition organized to fight the healthcare proposal.


The AMA, the country’s largest physician organization, confirmed Thursday that it is leaving the Partnership for America’s Health Care Future, an industry group that opposes Medicare for All.


The decision does not signal a policy change on the part of the AMA, which will continue to oppose a single-payer system.


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Canada plots response to U.S. import plan after meeting with stakeholders

8/16/2019


(FierceHealthcare)
Canadian health officials are expected to meet soon with their U.S. counterparts to detail major concerns over a proposal to set up drug importation.


Canadian Health Minister Petitpas Taylor had a roundtable meeting of stakeholders across the healthcare spectrum Monday to hear out how to respond to the U.S. import plan. The Department of Health and Human Services (HHS) released a plan last month to create a pilot project for states, wholesalers and pharmacists to import drugs from Canada offered at a cheaper price than in the U.S.


“Participants expressed their appreciation to the Minister for swiftly convening the group, and shared their perspectives on the importance of consistent patient access to prescription drugs as well as their concerns about anything that could lead to or worsen drug shortages in Canada,” said Health Ministry Spokesman Alexander Cohen.


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NBGH: Large employers have serious reservations about 'Medicare for All'

8/14/2019


(FierceHealthcare)
Employers have plenty of concerns about plans to expand Medicare coverage, a new survey shows.


For the first time, the National Business Group on Health (NBGH) polled large employers about Medicare expansion plans, including a single-payer “Medicare-for-All” system, as part of its annual report examining their healthcare strategies.


Among the top issues: the possibility that costs could rise and quality could decrease.


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Cummings, Sanders reopen 2014 probe into generic drug price fixing

8/14/2019


(FierceHealthcare)
Rep. Elijah Cummings, D-Maryland, and Sen. Bernie Sanders, I-Vermont, reopened a 2014 probe into whether generic drug manufacturers colluded to raise drug prices.


The two lawmakers, who have often collaborated on legislation to tackle high drug prices, are calling on Mylan, Heritage and Teva to turn over documents originally requested back in 2014 but were stonewalled. Sanders and Cummings initiated the probe in 2014 in 14 generic drug companies over massive spikes of up to 8,000% for generic doxycycline hyclate.


Heritage, Teva and Mylan did not return documents per the lawmakers’ requests back in 2014.


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Out-of-network billing costs at in-network hospital EDs more than doubled: study

8/13/2019


(FierceHealthcare)
It appears that out-of-network billing for inpatient admissions and emergency department (ED) visits is becoming more common and expensive for patients.


Publishing in JAMA Network, study researchers examined 5.4 million inpatient admissions and 13.6 million ED visits between 2010 and 2016 and found that more than 39% of ED visits generated an out-of-network bill and 37% of all inpatient admissions resulted in an out-of-network bill.


The analysis of the claims data for privately insured patient showed an increase from 32.3% to 42.8% of ED out-of-network bills during the time period.


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CMS: Unsubsidized enrollment drops 40% on ACA exchanges from 2016 to 2018

8/12/2019


(FierceHealthcare)
A new Trump administration report found that 2.5 million unsubsidized customers left the Affordable Care Act’s (ACA's) exchanges from 2016 to 2018, a 40% decrease.


The Centers for Medicare & Medicaid Services (CMS) said in a report released Monday (PDF) that the decline in 2018 follows a decrease of 1.3 million unsubsidized people in 2017. But, enrollment in the subsidized population has remained steady, according to the report.


“While data from the effectuated enrollment report shows stability in exchange enrollment and premium trends, affordability remains a significant challenge for people who do not qualify for exchange subsidies,” CMS said.


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Michigan Medicine makes AI, machine learning a top tech priority

8/12/2019


(Health Data Management)
The academic medical center of the University of Michigan is leveraging investments in artificial intelligence, machine learning and advanced analytics to unlock the value of its health data.


According to Andrew Rosenberg, MD, chief information officer for Michigan Medicine, the organization currently has 34 ongoing AI and machine leaning projects, 28 of which have principal investigators.


“There’s a lot of collaboration around these projects—as there should be for the diversity of thought and background needed to deal with complex problems—working with at least seven other U of M schools,” Rosenberg told the Machine Learning for Health Care conference on Friday in Ann Arbor, Mich. “That’s one of the powers that we enjoy.”


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Allscripts to pay $145M to resolve DOJ’s Practice Fusion investigations

8/12/2019


(Health Data Management)
EHR vendor Practice Fusion, acquired last year by Allscripts, has reached an agreement in principle with the Department of Justice to resolve HIPAA and federal anti-kickback law investigations.


In early 2018, Allscripts announced its plans to buy the physician practice vendor for $100 million in cash due—in part—to Practice Fusion’s “affordable” EHR technology. Now, Practice Fusion will end up costing Allscripts considerably more in a settlement with DOJ.


“Allscripts recorded a $145 million charge in the second quarter related to the DOJ investigations, which the company believes will be sufficient to resolve all potential civil and criminal liability in connection with these investigations,” the company announced in reporting its second quarter 2019 results last week.


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Insurance giant’s tense meeting with a senator adds to growing concern about Medicaid oversight

8/8/2019


(FierceHealthcare)
The ranking member of the Senate health committee has complained for months about the Trump administration’s failure to look into Medicaid contractors that have reaped big profits while sometimes failing to provide crucial patient services.


So last week, Sen. Bob Casey, D-Pa., called in the top boss of Centene, the nation’s largest Medicaid managed care company. He wanted to question the company about reports that its Texas subsidiary denied life-sustaining care to sick and disabled children—in one case, leaving a baby in foster care to suffer a catastrophic brain injury.


The meeting with longtime Centene CEO Michael Neidorff did not go well, according to Casey.


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