March 6, 2024

Walgreens Will Have Long Road To Recovery

Walgreens says that its road to financial recovery will be long – not a 12-month plan.  It is undertaking a strategic review of its business. It plans to cut $1 billion in expenses this year. 

Additional article: https://www.modernhealthcare.com/providers/walgreens-tim-wentworth-villagemd-shields-health-ownership

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Major Claims Reductions Reported In Light of Change Healthcare Cyber Attack

While UnitedHealth Group remains mum, Humana and Elevance Health say they are seeing a 15% to 20% reduction in data from providers since the Change Healthcare cyber attack. The rate of reduction is now down to 10% as providers and plans adapt to the outage from Change. Plans are adopting a reserve strategy to ensure a set aside for such claims in the future. Change Healthcare/Optum will likely lose a great deal of business as providers and plans lose faith in Change and migrate to other vendors.

Additional article on the fallout for providers, described as a “nightmare:” https://www.modernhealthcare.com/providers/change-healthcare-outage-hospitals-pharmacies

Another article on expected lawsuits from parties against Change: https://www.modernhealthcare.com/legal/change-healthcare-outage-cyberattack-lawsuits-minnesota-tennessee

(Some articles may require a subscription.)

#changehealthcare #cyberattacks

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New Urban Institute Report Urges Reform Of MA Star Program

A new report from the Urban Institute recommends some radical changes to the Medicare Advantage (MA) Star program.  I have some issues with the recommendations, but worth a perusal.  The report is not a hit piece, but generally does not recognize the value MA provides.

Urban Institute report here: https://www.fiercehealthcare.com/payers/experts-offer-medicare-advantage-quality-bonus-program-recommendations

#medicareadvantage #stars

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Trauma Centers Charge More For Routine Services

Another example of what is wrong with our pricing system. Because of their power in the market, trauma centers charge more than their counterparts for non-trauma admissions and emergency department visits.

#providers #hospitals

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Nursing Homes Limiting Admissions

Given the Centers for Medicare and Medicaid Services’ (CMS) staffing mandate, nearly half of nursing homes polled by the American Health Care Association are already limiting admissions.  This is a result of existing staffing shortages.

Another story shows how a key House Committee voted to ban the staffing mandate: https://www.modernhealthcare.com/politics-policy/cms-nursing-home-staffing-mandate-house-bill

(Article may require a subscription.)

#nursinghomes #staffing

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Democratic Lawmakers Demand CMS Require States To Enhance Medicaid Eligibility

Democratic leaders say CMS must better oversee how states fulfill compliance with Medicaid/CHIP enrollment and eligibility requirements.  This stems from the major problems related to the Medicaid redetermination process that was reintroduced in April, 2023.

(Article may require a subscription.)

#medicaid #redeterminations

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Biden Right That Americans Pay Twice What Others Do For Prescription Drugs

Good article in Kaiser Health News validating that Americans pay excessively for prescription drugs compared with other developed countries.  See my blog that comes to similar conclusions: https://www.healthcarelabyrinth.com/inflation-reduction-acts-medicare-price-negotiations-should-have-small-impact-on-innovation-but-positive-impact-on-american-lives-and-what-we-pay/ . Drugs in America are easily twice and sometimes well more than what they are in other developed coutries.

#drugpricing #brandrugmakers

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Biden To Propose Expansion Of Medicare Drug Price Negotiations

A STAT exclusive says that President Biden will propose an expansion of Medicare drug price negotiations. He will propose more drugs be negotiated sooner. Since the House is in GOP hands, the proposal is largely symbolic and meant for the upcoming election campaign.

#ira #drugpricing

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Email Messaging Claims In Healthcare

The Peterson-Kaiser Family Foundation has a good study of email messaging healthcare claims.  They spiked during COVID but continue to remain prevalent.


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House Passes Key Spending Bill

On 339-to-85 vote, the House passed one of two spending bills needed to avoid a government shutdown Friday.  The Senate is expected to pass the bill before the deadline. Eighty-three rightist Republicans opposed the bill.

Additional articles here: https://www.modernhealthcare.com/politics-policy/spending-bill-house-dsh-cut-physician-payment and https://insidehealthpolicy.com/daily-news/house-passes-first-approps-bills-skinny-health-package


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— Marc S. Ryan

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