What we're reading, November 2, 2015: third open enrollment under the Affordable Care Act kicks off; common medical tests are being done inaccurately; and hospitals and the government settle over cardiac device implants.
Open Enrollment Goes Off Without a Hitch
Over the weekend, the third open enrollment period under the Affordable Care Act opened without a hitch. The Washington Post reported that 40,000 applications were submitted through HealthCare.gov during the first 6 hours of operation. But it wasn’t all good news for the president’s healthcare reform: while HealthCare.gov and the state sites opened shop without incident, just days before open enrollment kicked off, yet another co-op—nonprofit, consumer-focused health plans—closed up shop.
Common Medical Tests Sometimes Inaccurate
A growing number of medical tests are being waived from oversight because they are considered so simple and accurate, but they are often being done incorrectly, reports Journal Sentinel. A spot check of facilities doing these tests found less than half were in compliance with policies in place to ensure safe, quality care.
Hospitals, Government Reach $250 Million Settlement Over Cardiac Device
The Justice Department has reached settlements totaling more than $250 million with 457 hospitals that implanted cardioverter defibrillators in violation of Medicare coverage requirements, according to Chicago Tribune. Medicare sets a waiting period up to 90 days before implanting the cardiac device, which costs $25,000, because trials have shown the heart often recovers its own rhythm without the intervention of the pricey device. The hospitals in question all implanted the device too soon.
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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Integrated CKD Care Model Cuts ED Visits by 30%, Boosts Specialized Treatment
April 21st 2025An analysis of an interdisciplinary care model for managing chronic kidney disease (CKD) shows hospital admissions dropped by 26% and emergency department (ED) visits decreased by 30% after clinic initiation.
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