February 14, 2024

Elevance Health Takeover Of BCBSLA On Hold Again

Facing pushback from Louisiana regulators, the governor and some lawmakers, BCBSLA has again withdrawn its application for sales to Elevance Health. BCBSLA sought permission to transition to a for-profit entity.

Additional article: https://www.modernhealthcare.com/mergers-acquisitions/elevance-health-blue-cross-louisiana-merger-called-off

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#bcbsla #elevancehealth

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Biden Administration To Scrutinize Middlemen In Drug Shortage Controversy

The Biden administration has issued a Request for Information (RFI) about the role of drug channel middlemen in creating drug shortages. The middlemen include group purchasing organizations (GPOs) and drug wholesalers. About six entities dominate. The Federal Trade Commission (FTC) and the Department of Health and Human Services (HHS) are leading the effort. The agencies will look at market concentration, contracting practices, and regulatory exemptions. In addition, GPOs’ sole-source agreements that prevent hospitals and other providers from acquiring drugs elsewhere will be examined.

HHS Press Release here: https://www.hhs.gov/about/news/2024/02/14/ftc-hhs-seek-public-comment-generic-drug-shortages-competition-amongst-powerful-middlemen.html

Additional articles here: https://www.modernhealthcare.com/supply-chain/ftc-gpos-group-purchasing-organizations-drug-wholesalers-antitrust and https://insidehealthpolicy.com/daily-news/ftc-hhs-probe-gpo-wholesaler-roles-drug-shortages

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#ftc #hhs #drugshortages

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Another Study Criticizes MA’s Role In Rural Hospital Crisis

This is yet another study that criticizes Medicare Advantage’s role in financial crises at rural hospitals. It concludes that more and more rural hospitals are in the red and it points in part to the rise of MA plans there. Also noted was impacts to rural hospitals in states that have no expanded Medicaid. About half of rural hospitals are losing money.

MA rose from 6.3 million in 2019 to 9.2 million in 2023 in rural areas.  MA now has about a 38% penetration in rural areas.

Given how MA works, it is not that rates paid to hospitals are necessarily lower. But rural hospitals argue that stays are denied upfront, payments are delayed due to scrutiny, and payments can be denied (or reduced) post service by MA plans. This all leads to lower overall revenue.

#ruralhealthcare #ruralhospitals #medicareadvantage

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Scan And CareOregon Call Off Merger

The Scan Group and CareOregon have called off a merger in light of ongoing concerns from Oregon regulators.

Additional article: https://www.modernhealthcare.com/insurance/scan-group-careoregon-merger-medicaid-medicare-advantage

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#scan #careoregon

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Prominent Lawmaker Says Partial Medicare Doc Fix Likely

Rep. Larry Bucshon, R-IN, a doctor himself, says Congress will likely partially fix the Medicare rate cut for doctors by early March.  But he says that prospects for a permanent fix may take several years. The rate was cut 3.4% as of January 1.  Providers lose a major supporter as Bucshon is not running for re-election.

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#providers #physicians #rates #medicare

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Third Way Wants Charity Care Reform

Prominent non-profit policy group Third Way wants Congress to pass a national charity care law.  In a new report, the group says non-profit hospitals’ tax breaks exceed the level of charity care. As such, it wants Congress to rein in hospitals’ debt collection practices, establish minimum requirements for charity care, and simplify how charity care is provided. Senate HELP Chairman Bernie Sanders has been active on the issue as well and largely agrees with Third Way.

Third Way report here: https://www.thirdway.org/report/a-national-charity-care-law-to-improve-nonprofit-hospitals

(Article may require a subscription.)

#hospitals #charitycare

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— Marc S. Ryan

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