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What We're Reading: Medicare Patient Readmission Fines; Open Enrollment Begins; Trump Rallies' Links to COVID-19
Nearly half of hospitals to get lower Medicare payments due to patients' readmission history; open enrollment begins for health coverage under the Affordable Care Act; study models projected cases and deaths from COVID-19 to the president's rallies.
Medicare Fines Hospitals for Readmitting Too Many Patients
Reported by Kaiser Health News, nearly half of hospitals in the United States will get lower payments for all patients covered by Medicare due to their history in readmitting patients. The fines, indicated by federal records, are the ninth annual round of the Hospital Readmissions Reduction Program implemented through the Affordable Care Act’s effort to improve quality and lower costs. The latest penalties come amid surges in cases of coronavirus disease 2019 (COVID-19) and resulting financial fallout, but were calculated based on each hospital case history before the pandemic, from July 2016 to June 2019. CMS announced in September they may suspend the program in the future if it proves too difficult to assess hospital performance amid the pandemic.
Open Enrollment Begins for ACA Plans; Georgia to Stop Using HealthCare.gov in 2023
Open enrollment for plans under the ACA began Sunday, but the Trump administration is not promoting the plans despite this being the first open enrollment period to occur in the midst of a pandemic that has caused widespread job loss. Even with the lack of publicity, Politico reported that most observers expect enrollment to hold steady. Separately, CMS Sunday night approved a plan to allow Georgia to stop directing people to healthcare.gov in 2023, sending them instead straight to insurance companies and private brokers.
Study Examines Trump Rallies' COVID-19 Spread
A statistical modeling study from Stanford University indicated that 18 of President Donald Trump’s campaign rallies held between June 20 and September 22, 2020 have led to over 30,000 confirmed cases of COVID-19, likely leading to over 700 deaths. The New York Times reported researchers compared spread of the virus in the counties that held the rallies to other counties that were similar in case trajectory before the rallies occurred, of which only 3 were held indoors. Study findings come amid a single-day record for cases of COVID-19 this past Friday, amounting to 97,080 new cases.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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