Insurance

Unplanned hospital readmissions, which affect more than 18% of Medicare beneficiaries each year, are generally understood to be tied to gaps in care coordination between hospitals and community healthcare providers, and new research suggests that readmission more than a week after discharge may be tied to patients’ inability to access appropriate outpatient care after discharge.

The American Hospital Association will refile its 340B lawsuit against HHS after an appeals court ruled the lawsuit was premature; therapies approved by the FDA with breakthrough designation often lack strong medical evidence; a study has suggested that frequent use of digital media may increase the odds of adolescents developing symptoms of attention-deficit/hyperactivity disorder (ADHD).

Following CMS’ announcement of proposed rules for the 2019 Medicare Physician Fee Schedule, Community Oncology Alliance (COA) released a statement calling the proposals “puzzling.” The statement details concern with 2 proposals.

Constraining access to HIV regimens can have significant implications for patients. This study examined the economic and health impacts of restrictive HIV formulary designs.

CMS Administator Seema Verma said the changes are designed to reduce administrative burdens for physicians so they can spend more time with patients. A group representing community oncologists said a reimbursement change for new drugs could have unintended consequences.

CMS proposed new rulemaking Wednesday to update 2019 Medicare payment policies for fee-for-service patients with end-stage renal disease (ESRD).

Likely due to a focus on preventive services, Medicare Advantage (MA) beneficiaries had lower rates of complications, hospitalizations, and emergency care services compared with fee-for-service (FFS) Medicare beneficiaries.

A day before legislators will hold hearings on 15 bills relating to the 340B drug discount program for hospitals, 340B Health, which represents those hospitals and providers, released a report that said more than half of the disproportionate share hospitals would lose eligibility under one Congressional proposal.

The Community Oncology Alliance (COA) has filed a lawsuit in the US District Court for the District of Columbia, stating that the 2% sequester cut to Medicare Part B drug reimbursement is unconstitutional and illegal, and that it can harm patient care and have a huge impact on the communityc ancer care system.

We've rounded up the top 5 most read articles of June, including trial results from the 2018 American Society of Clinical Oncology Annual Meeting and a FDA breakthrough therapy designation for a gene therapy.

The California state legislature approved a last-minute deal to halt soda taxes for 12 years; the Department of Justice charged 601 people for taking part in a variety of frauds and schemes that resulted in more than $2 billion in healthcare losses; Amazon buying PillPack, an online pharmacy, is exactly what the pharmacy business has been fearing.

Total and per capita annual growth rates in Medicare are trending higher than their historically low levels of the past few years, the Henry J. Kaiser Family Foundation reported recently in a review of Medicare data, creating an uncertain environment for future sustainability.

Oklahoma’s Medicaid program is the first to win approval from CMS to negotiate supplemental rebate agreements involving value-based purchasing (VBP) arrangements with drug manufacturers, with the aim of producing extra rebates for the state if clinical outcomes are not reached. Separately, CMS denied an application from Massachusetts requesting the ability to exclude certain Medicaid-covered outpatient drugs through a closed formulary.

A California law that requires clinics to notify women that abortions paid for by the state are available has been ruled a violation of free speech rights; half of all workers in the United States have health insurance with a deductible of at least $1000, which is up from 22% in 2009; a new study found that more seniors insured by Medicare are dying at home instead of a hospital.

Chronic care management is available under Medicare but has been underused thus far.

As radiation oncologists met with policy makers in Congress as part of the 15th annual American Society of Radiation Oncology Advocacy Day, the need for a radiation oncology–specific alternative payment model (APM) was one of the key topics of discussion.

A new study from the Healthcare Financial Management Association, Leavitt Partners, and McManis Consulting found that the penetration of value-based payment (VBP) models is not yet enough to generate cost savings and is also not affecting clinical quality outcomes at the market level.

Using the example of low back pain, a study in JAMA Open suggests insurers could help to reduce opioid overuse by expanding access to nonopioid alternatives through improved coverage and reimbursement policies.

Enrollment in Medicare Advantage plans has grown sharply to cover one-third of all Medicare beneficiaries. During that growth, customer satisfaction with these plans remains stable, according to a new report from J.D. Power.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

CMS Administrator Seema Verma said the agency is seeking public comment on the so-called Stark Law, which was enacted to prevent independent physicians from referring Medicare patients to facilities where they have a financial benefit. The agency said it was focusing, among other things, on how the law may impede care coordination.

The Justice Department said that Healogics, a Florida-based wound care chain, agreed to pay up to $22.51 million to settle allegations that it violated the False Claims Act by knowingly causing wound care centers to bill Medicare for medically unnecessary and unreasonable hyperbaric oxygen (HBO) therapy.

If you heard of a drug with a 387 percent return on investment, wouldn’t you want in? That was the result of a voluntary program in Maine that provided proper meals to high-risk Medicare patients leaving the hospital. Managed Care Cast explores results that appear in the current issue ofThe American Journal of Managed Care®.

Physicians participating in the Oncology Care Model now provider care for approximately 21% of Medicare patients with cancer. An analysis from Avalere Health found that those doctors treat some types of cancers more than others.

The Trump administration is proposing to halt the public disclosure of hospital infections on the CMS Hospital Compare website; the American Medical Association (AMA) is opposing the proposed merger between CVS Health and Aetna after an analysis of the impact; and health experts are warning about the short- and long-term health impacts of the current zero tolerance immigration policy.

Health insurer Humana and pharmacy chain Walgreens announced Tuesday they are opening joint primary care clinics for senior citizens in Kansas City, Missouri. Separately, a report from America’s Health Insurance Plans (AHIP) found that Medicare Advantage populations continue to be more diverse and represent a larger share of low-income seniors than traditional fee-for-service (FFS) Medicare beneficiaries.

Authors from Foundation Medicine explain the regulatory path that led to approval of FoundationOne CDx.

Health plans are under scrutiny to address social determinants of health, which include food insecurity and poor housing.

This week, the top managed care stories include the CDC says the suicide rate is rising; lawmakers ask when drug prices will start falling; and a policy change will allow people in Medicare to use their smartphone to manage diabetes.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.