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Healthcare News

 

CMS looking to define enforcement for its hospital price transparency rule

1/11/2019


(FierceHealthcare)
Now that hospitals are required to post chargemaster data online for patients to access, the Centers for Medicare & Medicaid Services is exploring the most effective ways to make sure providers comply with the rules.


CMS Administrator Seema Verma spoke to reporters Thursday morning and said the agency is continuing to gather feedback on what’s next for its price transparency efforts.


CMS finalized the price transparency requirement in August as part of its Inpatient Prospective Payment System rule. Verma acknowledged concern that providing patients with just the list prices for medical services could have limited usefulness, and said CMS hopes that the machine-readable format leads developers to provide more comparative tools. 


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Study identifies persistently high-cost Medicare patient trends

1/11/2019


(FierceHealthcare)
Persistently high-cost Medicare patients tend to be younger, members of racial or ethnic minority groups, dual-eligible Medicaid patients or suffering from end-stage renal disease (ESRD), a new study reports.


Medicare patients in the top 10% of spending each year accounted for almost 20% of Medicare’s overall spending during the three-year period covered by the study, published in the January issue of Health Affairs.


That makes them a prime target for policy initiatives aimed at reducing costs in the system, provided policymakers can get a handle on the causes for the high rate of spending.


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Insurers point to Medicare Advantage as they boast about growth

1/10/2019


(FierceHealthcare)
A common theme among insurers speaking at the J.P. Morgan Healthcare Conference this week: the boost from Medicare Advantage. Executives from several companies pointed to the program in their highlights as they discussed their upcoming year at the conference.


Humana officials said they have been beating Wall Street expectations over the past several quarters in part because of their MA business.


“[2019] is shaping up to be a very, very strong year,” said Chief Financial Officer Brian Kane. “We have revised upward our MA enrollment guidance. We expect individual MA growth this year to be 375,000 to 400,000 members. That’s a 12-13% growth rate. While we don’t have the CMS tape, which tells us how we did relative to the marketplace, our sense is that we’ll pick up meaningful share this year.”


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Molina Healthcare saw a stunning turnaround last year. Can the growth continue?

1/10/2019


(FierceHealthcare)
Has Molina Healthcare’s new leadership team been so successful in their company turnaround that they’ve run out of places to grow?


Not even close, CEO Joseph Zubretsky said during a presentation at the J.P. Morgan Healthcare Conference this week.


It has been the foremost question facing the company since staging a significant financial comeback over the last year by “harvesting” a number of savings and growth opportunities that took Molina from a net loss of $512 million at the end of 2017 to a net income of $197 million in its third quarter of 2018.


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U.S. spends far more on healthcare than other developed countries—and researchers say prices are still to blame

1/8/2019


(FierceHealthcare)
More than a decade after a group of health policy researchers concluded that the reason healthcare spending is so high stateside is the “prices, stupid,” an updated look at the issue identifies the same old problems.


Three of the four researchers on the 2003 study reconvened to compare data between Organization for Economic Cooperation and Development (OECD) countries on healthcare spending and came to much the same conclusion: “it’s still the prices, stupid.”


In 2016, the U.S. spent $9,892 per capita on healthcare, a number 25% higher than that for the next-highest country, Switzerland, which spent $7,919 per person. U.S. healthcare spending outstripped Canada's by more than 100%, according to the Health Affairs study


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Another impact of the government shutdown on healthcare? Legal delays

1/7/2019


(FierceHealthcare)
As the partial government shutdown stretches into its third week, it has had an impact on a growing number of health programs. It has also had an impact in another venue: the courtroom.


Starting last month, federal attorneys have requested stays across their collection of cases since appropriations for the Department of Justice lapsed.


That includes some battles involving healthcare organizations.


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Final Healthcare.gov enrollment numbers show drop due to cancellations

1/3/2019


(FierceHealthcare)
More than 8.4 million people enrolled for plans on Healthcare.gov this year, down about 4% from last year, according to final numbers released by the Centers for Medicare & Medicaid Services.


The enrollment number also shows a drop from preliminary figures of 8.5 million enrollments reported last month, something attributed to cancellations once all new plan selections, renewals, and automatic enrollments were taken into account. There were about 8.7 million signups last year.


CMS will release additional data in March that includes plan selection data from state-based exchanges that don't use Healthcare.gov.


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House Democrats mount ACA defense in rules package

1/3/2019


(FierceHealthcare)
House Democrats are aiming to give themselves the power to defend the Affordable Care Act from legal challenges—including a Texas ruling that declared the law unconstitutional.


The rules package (PDF) in the House for the new session of Congress includes a provision that would allow the speaker to “intervene” in litigation against the ACA. 


A Texas judge ruled that the ACA is unconstitutional, as the law’s individual mandate was repealed in December 2017 by a Republican-controlled Congress. The ruling faces a long legal path, and the law remains in effect through the appeal process. 


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How the government shutdown affects health programs

1/3/2019


(FierceHealthcare)
There seems to be no end in sight for the current partial government shutdown, the third since the beginning of the Trump administration.


For the vast majority of the federal government’s public health efforts, though, it’s business as usual.


That’s because Congress has already passed five of its major appropriations bills, funding about three-fourths of the federal government, including the Department of Health and Human Services and the Department of Veterans Affairs.


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Older Americans worried about insurance coverage, health costs as they approach retirement

1/3/2019


(FierceHealthcare)
A sizable percentage of Americans between the ages of 50 and 64 are worried about their healthcare coverage as they head toward retirement, according to a new poll from the University of Michigan.


Although some of these concerns include things people can’t directly control, such as policy changes, many are focused on maintaining current coverage provided through an employer while reducing personal healthcare expenses.


“The ACA’s insurance coverage expansion was intended, in part, to reduce 'job lock' and allow individuals to change or leave their job without concern about becoming uninsured,” the report says. “However, data from this poll suggest that many adults age 50–64 still worry about maintaining employer-sponsored health insurance and keeping a job for that reason.”


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