Prices of drugs for diabetes, heart failure and more will be up for negotiation in Medicare next year
The U.S. Department of Health and Human Services (HHS) on Tuesday announced the first 10 Medicare Part D drugs that will be subject to price negotiations, the headlining healthcare-related provision of the Inflation Reduction Act. Signed in August 2022, the law gave Medicare authority to negotiate with drug manufacturers over the prices of selected drugs.…
Billions of dollars in lump-sum payments are coming to hospitals as a remedy for 340B-related underpayments
Hospitals that participate in the 340B Drug Pricing Program stand to receive $9 billion in aggregate lump-sum payments as compensation for underpayments from Medicare during a nearly five-year period. In a proposed rule issued July 7, CMS described how it would provide remedies following a 2022 Supreme Court ruling that the U.S. Department of Health…
Annual Conference: Healthcare entrepreneur Alex Oshmyansky describes his efforts to disrupt drug pricing
Arguably no segment of the healthcare industry is more susceptible to disruption than the market for prescription drugs, as Alex Oshmyansky, MD, PhD, made clear Wednesday morning during the closing session of HFMA’s Annual Conference. Oshmyansky spoke about his personal efforts to disrupt the pharmaceutical market in his role as co-founder and CEO of Mark…
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How the CEO of Mark Cuban Cost Plus Drug Co. aims to upend the PBM model
W hen Alexander Oshmyansky, MD, PhD, pitched the idea of a not-for-profit drug company that would undercut drugmakers’ excessively priced pharmaceuticals, he was soundly rejected by potential backers, attracting no outside money. But on the advice to try to create a for-profit company instead, and with the later backing of Mark Cuban, things started to happen.…
Medicare’s proposed FY24 update to inpatient payments falls short, hospitals say
Hospitals are less than pleased with Medicare’s proposed FY24 payment update for inpatient care. In proposed regulations, the net inpatient payment update is 2.8% after factoring in a mandatory productivity adjustment of -0.2 percentage points. As usual, the update would be reduced for any hospital that does not fulfill quality-reporting requirements or qualify as a…
The impact of claims denials on the financial health of healthcare
While their hospitals and healthcare centers have long had to deal with claims denials, the number of denied claims continues to rise and payers are showing little inclination to help solve the problem, according to several roundtable participants.
The hospital labor picture could be improving, but a full financial recovery isn’t imminent
The financial and operational stress that has hampered hospitals may be easing in some ways, but probably not enough to qualify as a holiday gift for a beleaguered industry. Recent reports from credit-rating agencies have presented a mixed outlook. For example, Fitch Ratings released an analysis in December showing “incremental signs of improvement” in the staffing situation…
Healthcare News of Note: Telehealth aids outcomes for Medicare beneficiaries with opioid-use disorder
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Medicare beneficiaries initiating new episodes of OUD-related care get benefits from telehealth use, changes to inventory management strategies are coming for many sectors, and HAIs hit community hospitals hardest during the pandemic.
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