In federal ACO programs, advocates see signs of slow but steady progress
Growth in accountable care organization (ACO) programs has been inconsistent since the Affordable Care Act made accountable care part of the healthcare lexicon in 2010. Nonetheless, proponents are optimistic about the state of ACOs and their potential in upcoming years, even if there’s uncertainty about CMS’s ability to achieve its stated goal of ensuring every…
DOJ withdraws guidance that bolstered antitrust safe harbors for GPOs, cost benchmarking and more
Potentially leading to stricter enforcement of antitrust policy in healthcare, the U.S. Department of Justice has withdrawn guidance that essentially promoted certain arrangements in the industry. The Feb. 3 announcement from DOJ’s Antitrust Division amounts to a cancellation of so-called “safety zones” that were established in three sets of nonbinding guidance issued between 1993 and…
Expanding its capacity to disrupt healthcare, CVS Health shells out billions to buy Oak Street Health
A month after stating it hoped to gain a presence in primary care, CVS Health accomplished that goal with a massive deal that could fortify its efforts to advance value-based payment in healthcare. The proposed $10.6 billion acquisition of Oak Street Health, a provider of senior-focused primary care, adds to a portfolio of assets that…
The patient as the new payer: 5 opportunities to improve the patient financial experience
Patient collections have become an increasingly difficult challenge for hospitals due primarily to a shift in payer mix. Because of rising deductibles and increased patient responsibility, the percentage of healthcare provider revenue collected directly from patients increased to more than 30% from less than 10% over ten years, according to an article from HITLeaders. Faced…
(Updated 2) Texas court again backs providers in No Surprises Act independent dispute resolution litigation
A physician association continues to roil the No Surprises Act’s arbitration process through successful litigation. For the second time in a year, the Texas Medical Association (TMA) prevailed in court after arguing that regulations governing the independent dispute resolution (IDR) process do not comply with legislative intent. Barring a successful appeal, the Feb. 6 ruling…
Various data highlight the ongoing labor challenges facing hospitals and other healthcare providers
The healthcare labor picture may be stabilizing in some respects, but hospitals and other providers continue to feel the squeeze. The industry added 58,200 jobs in January, including 10,900 at hospitals and health systems, according to preliminary seasonally adjusted data from the U.S. Bureau of Labor Statistics. That jump follows an average monthly increase of…
In new final rule, CMS looks to claw back billions in overpayments to Medicare Advantage health plans
CMS has confirmed a new approach to its auditing of payments directed to Medicare Advantage health plans, but the agency says the regulatory burden on providers should not increase. A newly published final rule on risk adjustment data validation (RADV) establishes that CMS will use an extrapolation methodology to recoup overpayments to MA plans beginning…
OIG describes how hospitals can use NPs to treat patients without violating the Anti-Kickback Statute
An advisory opinion from the HHS Office of Inspector General (OIG) appears to give hospitals leeway to expand their use of nurse practitioners in specific situations without violating the Anti-Kickback Statute. OIG issued the opinion in December in response to an inquiry from an unnamed acute care hospital. The hospital was seeking clarification on whether…
Norton Healthcare and other health systems are making big moves to reduce health inequity
When Louisville police officers killed Breonna Taylor, a young Black woman not suspected of any crime, in her home in March 2020, the president and CEO of Norton Healthcare took it personally. “As an employer of 18,000 people and a very prominent organization in our community, we needed to be the ones to step up…
Norton Healthcare commits time, money to improving health equity
In June 2020, Norton Healthcare, the largest health system in Louisville, announced five imperatives to address health inequities, four of them being: Start a health equity institute Improve diversity in its leadership ranks Educate its staff to advocate for health policy issues Invest more money to address health needs in underserved areas The remaining item…