May 15, 2024

Bipartisan Senate Bill Would Reform Medicare Primary Doc Pay

A bipartisan bill would tell the Centers for Medicare and Medicaid Services (CMS) to establish hybrid payments to reward primary care providers in the Medicare fee-for-service (FFS) program who provide the best care to their patients, including reducing patients’ emergency visits, hospitalizations, excess specialist services, and other big cost drivers.

Additional article: https://insidehealthpolicy.com/daily-news/whitehouse-cassidy-unveil-primary-care-payment-reform-related-rfi

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#primarycare #medicare


Upstate New York Hospital Stops Suits Against Patients

Rochester Regional Health has barred all aggressive collection activities, including lawsuits, related to unpaid bills. Others in the nation have followed suit.

#surprisebilling #healthcare #hospitals


New Sanders Report Says Weight-Loss Drugs Could Bankrupt System

A new report from Sen. Bernie Sanders, I-VT, says weight-loss drug Wegovy could bankrupt the healthcare system if there is no reduction in price and there is a reasonable uptake of the drug for those overweight or obese. Spending on all weight-loss drugs could hit $1 trillion annually.

Additional article: https://www.modernhealthcare.com/politics-policy/novo-wegovy-ozempic-weight-loss-drug-prices-bernie-sanders-medicare-medicaid

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#weightlossdrugs #drugpricing #branddrugmakers


Mega Hospital Merger Proposed In PA

Jefferson Health and Lehigh Valley Health Network have signed a definitive agreement to merge.

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#hospitals #consolidation #mergers


Two-Midnight Rule Contributing To Cost Increases In MA

Good article discussing the new 2024 Medicare Advantage (MA) prior authorization (PA) rule requiring that plans use fee-for-service (FFS) criteria, not their own.  Part of that includes following rules that allow providers (not MA plans) to determine if inpatient (IP) hospital stays are needed. This is known as the two-midnight rule.  The consensus of big plans is that that they need to follow the rule and it is adding to costs. Some hospitals say Q1 inpatient increases were tied in part to the rule, while others do not. The American Hospital Association (AHA) believes the rule has added to increased IP days. Another study suggests that over 22% of MA observation stays last year would have been billed as an IP stay under the new rule. Thus, this will become a huge cost driver in the future as the Centers for Medicare and Medicaid Services (CMS) enforce it through audits.

Additional article: https://www.beckershospitalreview.com/finance/2-midnight-rule-could-affect-20-of-medicare-advantage-patients.html? and https://www.healthcaredive.com/news/for-profit-healthcare-providers-inpatient-volumes-capital-spending-q1-2024/715880/

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#priorauthorization #medicareadvantage


House GOP On Attack Over Enhanced Subsidies

House GOP leaders are on the attack regarding the proposed extension of the enhanced subsidies in the Exchanges.  And extension would cost $335 billion over a decade. If the House GOP retains control of the chamber – it will fall to a few dozen swing seats – extension after 2025 is likely dead.

(Article may require a subscription.)

#aca #obamacare #exchanges #coverage


Groups Call For Balanced Approach To AI Regulation

Good article on various groups call for a balanced approach to AI regulation.

#ai #healthcare


United Healthcare Comfortable With MA Prospects

While many of the big plans, including Humana and CVS Aetna, are worried about finances in MA and plan benefit and enrollment reductions, United Healthcare is signaling relative comfort with the future.

#medicareadvantage #unitedhealthcare #cvshealth #aetna #humana


Kansas Awards New Medicaid Contracts

Aetna was not re-upped in a new Kansas Medicaid award, while United Healthcare and Centene were awarded a new contract.

#medicaid #managedcare #ks


As Election Heats Up, Polls Show Healthcare Pull

A new Kaiser Family Foundation (KFF) poll shows Americans have a favorable opinion of the Affordable Care Act (ACA), 62-37. More Americans trust Biden than Trump on healthcare issues. Solid majorities of all parties favor additional Medicare drug price negotiations. As well, solid majorities of all parties worry about the future of entitlements. Must read to understand all elements polled.

Meanwhile, Democrats are using healthcare ads to target Republicans in swing districts.

Additional articles: https://thehill.com/homenews/house/4663915-health-advocacy-biden-district-republicans/ and https://www.kff.org/interactive/kff-health-tracking-poll-the-publics-views-on-the-aca/#?response=Favorable–Unfavorable&aRange=twoYear and https://www.kff.org/affordable-care-act/press-release/new-kff-poll-finds-that-many-older-voters-are-unaware-of-medicare-drug-price-negotiation-but-awareness-has-grown/

#election2024 #healthcare


— Marc S. Ryan

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