CMS and other stakeholders take steps to improve prior authorization in Medicare Advantage and beyond
Several recent developments point to an industrywide effort to ease the burden of prior authorization. Most notably, CMS on April 5 finalized a rule that includes provisions designed to improve prior authorization in Medicare Advantage (MA) starting with the 2024 plan year. The rule addresses a few aspects of prior authorization, among them the way…
Court decision means cost sharing could be reinstated for some preventive healthcare services
Comprehensive coverage of some preventive care services could be jeopardized by a recent court ruling. Since its passage, the Affordable Care Act (ACA) had required health plans to cover the full cost of services that received an “A” or “B” rating from the U.S. Preventive Services Task Force (USPSTF). A federal judge in Texas ended…
Maryland’s all-inclusive population health payment model continues to show promise, but nonhospital spending poses a concern
An innovative payment model for Maryland healthcare providers has improved utilization, cost and quality thus far, but an increase in nonhospital spending requires further study. The Center for Medicare & Medicaid Innovation (CMMI) released an analysis of the first three years of Maryland’s Total Cost of Care Model, an effort to improve population health management.…
News Briefs: Financial and operational pressures continue for hospitals amid scattered positive signs
Recent financial data for the hospital industry illustrate continuing challenges even as some trends improve. Fitch Ratings released an analysis in early March that offers scant reason for optimism. Titled “Early NFP hospital medians show expected deterioration; will worsen,” it draws on data from hospitals with earlier 2022 financial year-ends. Those numbers show “materially weaker…
Joe Fifer: The courage to reframe healthcare to encompass ‘health’
Whether you’ve worked in this field for a day or a decade, when someone asks you what business you’re in, the answer is easy: Healthcare. And your meaning is clear. Imagine if you had answered, “health,” instead. Suddenly, that word raises more questions than it answers. Does the health business refer to fitness or nutrition,…
Reports on patient safety indicate progress, challenges and a need to focus on pediatric mental health
Recent reports add context to the issue of patient safety in hospitals and health systems. ECRI released a report that ranks the pediatric mental health crisis as the No. 1 patient safety issue in healthcare. The report cites a JAMA study that found increases of 29% in anxiety and 27% in depression between 2016 and…
Healthcare 2030: Leveraging good leadership to work toward financial sustainability
HFMA Senior Editor Paul Barr discusses Volume 2 of the Healthcare 2030 series. Katie Sklarsky from Chartis talks about financial sustainability, and Danielle Solomon from FORVIS talks about the importance of good leadership in times of change.
Healthcare News of Note: Medicare to negotiate reduced prices for 40 drugs by 2028, says study
Medicare drug price negotiation has the potential to benefit Medicare beneficiaries across some of the most common disease states.
Healthcare News of Note: Most board members of the nation’s top hospitals work in finance or business
Less than 15% of board members at a sampling of the nation’s top hospitals are health professionals, while 56% work in finance or business. Since 2014, the number of medically disenfranchised people in the U.S. nearly doubled from 56 million to over 100 million, causing stress for providers and lower rates of immunization and rising…
David Johnson: Why healthcare’s cupboard is bare — its funding gravy train has run out of steam
Gravy train is a railroad term that originated in the early 1900s. It described a well-paid train run that didn’t require much effort. In modern parlance, speakers use it to describe easy-to-do tasks and cushy situations. The problem with gravy trains is that riding them too long engenders lazy, sloppy and wasteful behaviors. New York…