Affordability of healthcare is not enhanced when providers form health systems, studies find
The efficiencies gained when providers operate as a health system don’t always translate to care that is more cost-effective, according to two recently published JAMA studies on pricing. In one study, researchers with Harvard Medical School and the National Bureau of Economic Research (NBER) examined 2018 data from various sources, including CMS administrative data, IRS…
News Briefs: Healthcare industry disrupter CVS Health to shell 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…
Hospital price transparency update: Regulatory enforcement soon could become stricter, CMS leaders say
Although nothing is official, CMS leaders indicate enforcement of hospital price transparency regulations is set to become more stringent. For an article published in Health Affairs, the Center for Medicare’s Meena Seshamani, MD, PhD, director, and Douglas Jacobs, MD, chief transformation officer, touted progress that has been made since the rules took effect Jan. 1,…
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Potentially leading to stricter enforcement of antitrust policy in healthcare, the U.S. Department of Justice has withdrawn guidance that essentially promoted certain arrangements in the industry.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…
(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…