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June 14, 2024

New Study Suggest FTC Scrutiny Of Hospital Mergers Is Meager A new study says the Federal Trade Commission’s (FTC) scrutiny of mergers is low and mergers lead to increased prices. Part of the issue is low funding for the FTC. (Article may require a subscription.) #ftc #manda #mergers #acquisitions #hospitals https://www.modernhealthcare.com/mergers-acquisitions/antitrust-enforcement-falls-short-hospital-mergers-study More On 2024 MA Star Recalculations Additional articles on the Centers for Medicare and Medicaid Services (CMS) decision to recalculate Star scores for 2024 and reopen bids for those who received higher scores. Reports suggest 76 contracts with 44 health insurers would gain at least 0.5 Stars. This could mean an additional $1 billion in revenue to plans, which goes out to members in added benefits. Some big plans receive additional dollars. Additional article: https://www.fiercehealthcare.com/payers/report-medicare-advantage-quality-ratings-get-new-calculations #medicareadvantage #stars #cms https://www.healthcaredive.com/news/cms-recalculates-medicare-advantage-star-ratings/718967 Are Lawmakers Serious On Stabilizing Medicare? Members on each side of the aisle on the House Budget Committee said they

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June 13, 2024

CMS To Recalculate 2024 Medicare Advantage Star Ratings After losing two lawsuits on their methodology, the Centers for Medicare and Medicaid Services announced it has recalculated 2024 Star measures for Medicare Advantage (MA) plans.  It will give plans that saw increases a short window to revise 2025 plan bids and benefits that have already been submitted. Additional article here: https://insidehealthpolicy.com/daily-news/scan-cms-recalculate-ma-star-ratings-rebidding-process-come (Some articles may require a subscription.) #medicareadvantage #stars #cms https://www.beckerspayer.com/payer/cms-to-recalculate-medicare-advantage-star-ratings-report.html Major MedPAC Recommendations In Annual Report MedPAC, the congressional policy arm for Medicare, issued its annual report today. It analyzes and makes recommendations for reforming Medicare physician pay, prior authorization in Medicare Advantage (MA), and MA encounter data. I will do an in-depth blog in the near future on the MA recommendations. (Article may require a subscription.) #medpac #medicare #providers #medicareadvantage #healthplans https://insidehealthpolicy.com/daily-news/medpac-june-report-examines-physician-fee-pay-prior-auth-irf Progressive Warns Of Medicare Drug Negotiation Repeal The Center for American Progress (CAP), a progressive policy group

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June 12, 2024

National Healthcare Spending Projections The Centers for Medicare & Medicaid Services (CMS) Office of the Actuary released its annual re-estimates of spending over a 10-year horizon.  While 2023 healthcare expenditures will be finalized in December, current estimates are that national healthcare spending grew by 7.5% in 2023 to about $4.8 trillion, or 17.6% of gross domestic product (GDP). Part of the costs were record coverage. Medicare spending is projected to have grown 8.4% in 2023, with costs over $1 trillion. Private health insurance spending is expected to have increased 11.1%.  Medicaid spending is expected to have grown by 5.7%.  This is lower due to dropping enrollment. National health expenditures will rise to $7.7 trillion and capture nearly one-fifth of the U.S. economy by 2032. I will have a blog next week digging into all the stats. Additional articles: https://www.modernhealthcare.com/policy/national-health-spending-projected-reach-77t-2032-cms and https://www.healthcaredive.com/news/national-healthcare-spending-growth-cms-report/718718/ and https://www.cms.gov/newsroom/press-releases/cms-releases-2023-2032-national-health-expenditure-projections (Some articles may require a subscription.)  #healthcare

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June 11, 2024

More Information On Elevance Health Star Lawsuit Win Yesterday we told you about Elevance Health’s win in court on the 2024 Star calculations.  Other healthcare publications have written stories today.  The pressure is on the Centers for Medicare and Medicaid Services (CMS) to respond.  I have also linked the lawsuit below. Additional articles: https://www.modernhealthcare.com/insurance/elevance-medicare-advantage-star-ratings-lawsuit-cms and https://www.beckerspayer.com/payer/elevance-health-gets-partial-victory-in-star-ratings-lawsuit.html#:~:text=The%20judge%20ruled%20partially%20in,only%20for%20BCBS%20of%20Georgia.  and https://www.healthcaredive.com/news/elevance-wins-medicare-advantage-star-ratings-lawsuit-hhs/718550 Opinion: https://www.documentcloud.org/documents/24740919-elevance_becerra_6724_order (Some articles may require a subscription.) #medicareadvantage #stars #cms https://www.fiercehealthcare.com/payers/elevance-health-earns-partial-win-legal-fight-over-ma-star-ratings Hospitals Raise Issues With Medicare Rate Hike And Requirements Hospitals pushed back on the Centers for Medicare and Medicaid Services’ (CMS) proposed regulatory changes and rate hikes. Hospitals raised concerns about new quality reporting requirements and changes to medical residency training programs.  It claimed the 2.6% rate hike was inadequate. At the same time, hospitals are opposing site-neutral payments, which would save the system and patients huge sums. #hospitals #medicare https://www.fiercehealthcare.com/providers/hospital-groups-push-back-cms-woefully-inadequate-inpatient-pay-bump-fy2025 Humana Finds VBC Payments Impact Kidney Care Humana has

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June 10, 2024

Elevance Wins Star Lawsuit A second lawsuit has been decided in favor of a Medicare Advantage (MA) plan and against the Centers for Medicare and Medicaid Services (CMS) on the calculation of Star scores. In this case, Elevance Health won its suit and a judge declared that Georgia contract scores must be revised. It will be increasingly difficult for CMS to ignore these rulings. I will write on this on LinkedIn tomorrow. (Article may require a subscription.) #medicareadvantage #cms #stars #elevancehealth https://www.modernhealthcare.com/insurance/elevance-medicare-advantage-star-ratings-lawsuit-cms White House Announces Cybersecurity Support For Hospitals The White House announced that Microsoft and Google will provide free or discounted support to help hospitals strengthen their cybersecurity. (Article may require a subscription.) #hospitals #cybersecurity https://www.modernhealthcare.com/politics-policy/google-microsoft-cybersecurity-rural-hospitals-safety-net Supreme Court To Hear Hospital Funding Case The Supreme Court said it will review a lower court decision that limits Medicare payments for hospitals under the federal disproportionate share hospital program. It is a rather

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June 7, 2024

Oscar Continues Good Performance, Lays Out Strategy Oscar Health reports its first quarterly net profit and hit 1.5 million enrollees in the Exchanges. It plans on investing in individual coverage health reimbursement arrangements (ICHRA) in tandem with its Exchanges offerings as well as re-entering Medicare Advantage. Additional article: https://www.beckerspayer.com/payer/oscar-health-plans-to-double-its-membership-5-things-to-know.html #oscar #exchanges #aca #obamacare #ichra #medicareadvantage https://www.fiercehealthcare.com/payers/oscar-health-growth-ambitions-doubling-its-footprint-planned-ichra-products-launch-and-more The Troubles Of Retail Meets Healthcare Good article on the general struggles with low-reimbursed primary care and additional challenges retailers have had. #retailmeetshealthcare #primarycare #healthcare https://www.fiercehealthcare.com/retail/industry-voices-walmarts-exit-health-centers-reflects-broader-challenges-primary-care Kroger Health Offering GLP-1s Kroger Health joins a growing number of providers driving expensive GLP-1 weight-loss drugs.  This is bound to continue to drive the shortages those with disease states face. (Article may require a subscription.) #kroger #weightlossdrugs #drugpricing https://www.modernhealthcare.com/patient-care/kroger-health-little-clinics-glp-1s-wegovy-zepbound Walgreens Will Not IPO Boots Struggling Walgreens Boots Alliance Inc. is killing an initial public offering for its UK Boots drug chain. It may still be looking for

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June 6, 2024

Medicaid Redeterminations Challenge Plan Finances More coverage of the challenges facing Medicaid managed care with dropping enrollments and rising risk.  I pointed out this possibility in a recent blog here: https://www.healthcarelabyrinth.com/health-plan-economics-part-3-how-falling-medicaid-enrollment-is-impacting-health-plans-and-providers-alike/ (Article may require a subscription.) #medicaid #redeterminations #healthplans managedcare https://www.modernhealthcare.com/insurance/how-medicaid-redeterminations-process-affecting-insurers CVS, Humana Will Lead Cuts To Medicare Advantage A very good article reporting on the current issues facing Medicare Advantage (MA) plans in 2025.  Many plans, especially Humana and CVS Aetna, are expected to pare added benefits back dramatically and could even contract geographies. Hundreds of thousands are expected to have to change plans.  How this all plays out is anyone’s guess, but United could pick up many lives. One interesting note is that margins are eroding but appear to be better with Dual Eligible Special Needs Plans (D-SNPs). In 2021, D-SNPs had margins of 6.4% vs. 2.2% for MA overall. See these blogs I did on the MA

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June 5, 2024

Nursing Home Staffing Mandate Under Fire President Biden’s pro-union nursing staffing mandate is now facing bipartisan opposition in Congress. The rule threatens to create a consolidation in the nursing home industry with small, independent firms selling to big chains because they cannot meet or afford standards. A lawsuit also seeks to challenge Biden’s authority to set such staffing requirements. (Article may require a subscription.) #nursinghomes #healthcare https://www.modernhealthcare.com/providers/cms-nursing-home-staffing-mandate-james-lankford-joe-manchin Antitrust Case Against Sutter Will Again Proceed A U.S. appeals court overturned a 2022 ruling that said Sutter Health did not engage in anticompetitive practices. The case is now reopened due to the fact that the jury did not hear crucial evidence. (Article may require a subscription.) #antitrust #healthcare https://www.modernhealthcare.com/legal/sutter-health-antitrust-lawsuit-verdict-appeal Prominent Senator Lays Blame on HHS For Cyberattacks Senate Finance Chairman Ron Wyden, D-OR, laid blame for the recent Change Healthcare cyberattack on the Department of Health and Human Services (HHS), saying it

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June 4, 2024

Scan Wins Lawsuit Over Star Ratings A federal judge said the Centers for Medicare and Medicaid Services violated the Administrative Procedures Act when it deviated from current regulations to calculate Star scores for 2024.  It was a significant win for Scan and Medicare Advantage (MA) plans in general.  It also could throw 2025 bids and benefit designs as well as 2025 Star measure calculations into flux.  I will have a blog on this on Thursday.  In the meantime, check out my LinkedIn post on the issue here: https://www.linkedin.com/posts/marc-s-ryan-%F0%9F%87%BA%F0%9F%87%A6-1a99529_scan-wins-medicare-advantage-star-ratings-activity-7203759541530808320-CEd6?utm_source=share&utm_medium=member_desktop Additional articles: https://www.beckerspayer.com/payer/scan-beats-cms-in-medicare-advantage-star-ratings-lawsuit.html and https://www.fiercehealthcare.com/payers/judge-sides-scan-health-plan-dispute-cms-over-medicare-advantage-star-ratings and https://www.healthcaredive.com/news/scan-health-plan-medicare-advantage-star-ratings-lawsuit/717976/ (Some articles may require a subscription.) #stars #medicareadvantage #cms https://www.modernhealthcare.com/law-regulation/scan-medicare-advantage-star-ratings-lawsuit-cms Steward Gets Permission On Timeline To Sell Assets Bankrupt Steward Health Care received permission from a bankruptcy judge to sell off its assets on an aggressive timeline.  Federal and state regulators have complained that they may not be able to perform adequate reviews. It is

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June 3, 2024

BCBS KC Will Exit Medicare Advantage Blue Cross and Blue Shield Kansas City has announced it will exit the Medicare Advantage (MA) program.  This shows the challenges created by some poor decisions by the Centers for Medicare and Medicaid Services (CMS).  I had said that many regional plans would pick up lives as major plans offload them due to investor concerns.  Will this be a trend or an exception? #medicareadvantage #coverage #cms https://www.fiercehealthcare.com/payers/blue-kc-exiting-medicare-advantage-market-2025-due-regulatory-demands Cigna Layoffs Cigna’s Evernorth services arm will lay off some specialty health center employees in favor of a focus on primary care. (Article may require a subscription.) #cigna #evernorth #healthcare #layoffs https://www.modernhealthcare.com/insurance/cigna-evernorth-care-layoffs-closings CVS Searching For Investment Partner For Oak Street This article speculates a good deal on CVS Health’s search for an investment partner to expand Oak Street, its primary care arm. (Article may require a subscription.) #cvshealth #primarycare https://www.modernhealthcare.com/providers/cvs-health-oak-street-private-equity-investment Grassley Wants To Understand Ascenion’s Ties To

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