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May 24, 2024

May 24, 2024 No Comments

Nursing Homes Sue On Staffing Ratios Nursing home associations are suing in federal court to overturn a new staffing ratio rule. The rule will lead to a massive consolidation in the industry and the loss of independent homes. Additional articles: https://www.modernhealthcare.com/providers/nursing-home-staffing-mandate-ahca-lawsuit and https://insidehealthpolicy.com/daily-news/nursing-homes-sue-cms-over-staffing-rule-aarp-backs-agency (Some articles may require a subscription.) #nursinghomes #staffing https://www.fiercehealthcare.com/providers/nursing-home-groups-file-lawsuit-block-cms-staffing-mandate More Layoffs At Highmark Highmark Health, a PA-based Blue, is undergoing a third round of layoffs. Additional article: https://www.modernhealthcare.com/labor/highmark-health-layoffs-engen (Some articles may require a subscription.) #healthcare #healthplans #layoffs https://www.beckerspayer.com/workforce/a-third-round-of-highmark-job-cuts.html House Budget Committee Rallies Around Consolidation Scrutiny And Site-Neutral Policies The House Budget Committee seems to have a bipartisan consensus on reining in hospital consolidations and mergers. As well, there seems to be consensus on the need to enact site-neutral payments.  Hospitals will vigorously object and try to torpedo any bill. A bill to begin such policies passed the House but did not in the Senate. #hospitals #consolidations #mergers #manda

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May 23, 2024

May 23, 2024 No Comments

Physician Pay Up; Docs Want Medicare Fix Physician pay increased by 5.9% in 2023 after dropping 2.4% in 2022. At the same time, physician groups were on Capitol Hill lobbying for a Medicare physician payment fix and more changes to prior authorization. Some indicated that it was hard to compete against hospital-owned docs because of higher payments. The independent docs want site-neutral payments implemented. Additional article: https://www.fiercehealthcare.com/providers/20-highest-paid-specialties-2023-doctors-see-6-boost-pay-doximity #physicians #rates #medicareadvantage #medicare #priorauthorization #siteneutral https://www.medpagetoday.com/practicemanagement/reimbursement/110302 Numerous Layoffs Hitting Healthcare Numerous layoffs are hitting healthcare. In the health plan world there have been notable layoffs, including at United’s Optum. UPMC’s health system is laying off as is Walmart in its soon-to-be-shuttered healthcare division. Additional articles: https://www.fiercehealthcare.com/finance/fierce-healthcare-layoff-tracker-highmark-axes-200-jobs-march and https://www.modernhealthcare.com/providers/walmart-health-layoffs-virtual-care-phoenix (Some articles may require a subscription.) #walmart #upmc #healthcare https://www.fiercehealthcare.com/providers/upmc-mckinsey-layoffs-organizational-restructure-university-pittsburgh-medical-center Express Scripts Embracing Independent Pharmacies In an effort to boost its image after bad press regarding pharmacy benefits managers (PBMs), Express Scripts is entering

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May 22, 2024

May 22, 2024 No Comments

Providers Lose 340B Lawsuit Appeal To Drug Makers A U.S. Court of Appeals ruled that drug makers can limit and impose conditions on pharmacies participating in the 340B drug discount program. The federal government had sided with providers, but a federal court ruled against that position. I am no friend of drug makers but this ruling is a good one.  The 340B program has been corrupted and abused by providers. It is not fulfilling its mission of getting discounted drugs to the most vulnerable.  Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/second-appeals-court-rules-drug-makers-can-impose-340b-restrictions (Some articles may require a subscription.) #340b #drugmakers #hospitals #providers https://www.healthcaredive.com/news/appellate-court-rules-drugmakers-340b-novartis-pharmacies-specialty/716814 Hospitals Attack Drug Makers On Price and Shortages — But Here Is The Other Story A new analysis by a hospital lobby says that drugmaker price hikes as well as drug shortages jeopardize patient access to care. I do not doubt the conclusion, but would also point out that hospitals abuse the system

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May 21, 2024

May 21, 2024 No Comments

Wyden Wants Tough Stance On Exchange Agents and Brokers Finance Chair Ron Wyden wants the Centers for Medicare and Medicaid Services (CMS) to crack down on rogue brokers and agents in the nation’s Exchange signup process.  (Article may require a subscription.) #exchanges #agents #brokers #fwa  https://www.modernhealthcare.com/insurance/ron-wyden-cms-exchange-marketers-aca Huge Proliferation Of Firms Devoted Just To GLP-1s More and more startups are popping up to promote GLP-1 use just for weight loss.  This caters to the better off.  Hims and Hers has been around for awhile and is jumping on the bad wagon but by offering compounded versions, largely due to the shortages. The overall trend has been a disservice to the nation as it tends to create shortages for those who need the drugs for disease state treatment. A new analysis by Kaiser says high prices of such drugs also lock out those with modest incomes. Additional article: https://www.modernhealthcare.com/digital-health/hims-hers-wegovy-weight-loss-drugs-novo-nordisk-eli-lilly-zepbound (Some articles may

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