Susan Dentzer: It is time to move past denying the perfect storm facing U.S. healthcare
The healthcare sector is facing a perfect storm of aging patients, rising costs, aging providers, and a shortage of primary care physicians, creating a need to a shift toward preventive care, increased use of technology, more virtual and home care and sustainable care teams.
Mandatory Medicare bundled payments and respiratory disease reporting are on the way for hospitals
Hospitals in nearly a quarter of U.S. markets soon will be required to participate in a Medicare bundled payment model covering five surgical procedures, CMS said in newly released regulations. The model is among several policies of note in Medicare’s FY25 final rule for hospital inpatient care and long-term care hospitals. See this previous article…
CMS proposes to hold Medicare ACOs harmless for spending levels stemming from catheter-billing fraud
CMS has issued a proposed rule to mitigate the impact of a high-profile Medicare fraud scheme on accountable care organizations (ACOs). The rule seeks to address “significant, anomalous and highly suspect billing activity for selected intermittent urinary catheters on Medicare Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) claims” as applied to ACOs in the…
Annual Conference Day 4: Geeta Nayyar discusses information gaps and the promise and perils of technology
Applications of technology and the purveyance of information are key issues impacting the efficacy of the healthcare system, author and healthcare technology expert Geeta Nayyar, MD, MBA, explained during Thursday’s keynote session in Las Vegas. In a sit-down discussion with HFMA President and CEO Ann Jordan, Nayyar described working at the intersection of medicine and…
The key role of downside risk in the success of value-based care
The basic idea behind value-based care (VBC) is simple. By encouraging providers to focus on the value rather than the volume of the services they deliver, it should be possible to achieve the twin goals of lowering healthcare costs and improving clinical outcomes. Given that the United States now spends far more per capita on…
A new DOJ task force is the latest example of intensified federal oversight of healthcare antitrust issues
A new task force at the U.S. Department of Justice (DOJ) is likely to bring additional scrutiny on whether healthcare transactions adversely affect competition. The department’s Antitrust Division announced the formation of a group to “consider widespread competition concerns shared by patients, healthcare professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor…
David Johnson: Site-neutral payment and the battle for healthcare’s soul
In a remarkable and surprising show of bipartisanship, the U.S. House of Representatives passed the Lower Costs, More Transparency Act on Dec. 11, 2023, by an overwhelming 320-71 vote. Avoiding hyperbole, the act lives up to its name. It seeks to equalize Medicare payment for the same drugs administered in the same way, whether in…
CMS calls for hospitals to be subject to a new bundled payment model and data-reporting requirements
Notable policies in Medicare’s FY25 proposed rule for inpatient hospital care and long-term care hospitals include the formation of a mandatory bundled payment model and requirements for hospital data reporting. Although the proposed payment rate was the headlining aspect of the rule for hospitals, the policy developments could have a longer-term impact on segments of…
Insurers see reasons for concern as CMS keeps the Medicare Advantage purse strings tight for 2025
Medicare Advantage (MA) faces the prospect of constrained revenue and payments for participating stakeholders after CMS finalized what amounts to a small decrease in the 2025 payment rate. Average revenue for MA plans is projected to increase by 3.7%, or more than $16 billion — but that’s primarily because of a prospective increase in the…
Responses to a new RFI will help guide regulations addressing consolidation and private equity in healthcare
The Biden administration is ramping up its assessment of how to regulate consolidation and private equity (PE) acquisitions in healthcare, issuing a request for information (RFI) from stakeholders. There is a deadline of May 6 to submit comments on the RFI, which was distributed by HHS, the Department of Justice (DOJ) and the Federal Trade…