Insurance

This article explores Northwestern Medicine’s decision to participate in a Medicare alternative payment model (APM) despite projected losses.

CMS made an “error of law” when it tried to expand a site-neutral payment system, a federal judge ruled.

Providing access to complex therapies through the Medicare market can benefit patients who are disproportionately ignored by socioeconomic status, said Scott Gottlieb, MD, former FDA commissioner (2017-2019).

CMS' new radiation oncology payment model is slated to begin on January 1, 2020, but the significant billing changes that the model requires will require more time.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

An evaluation of the Multi-Payer Advanced Primary Care Practice Demonstration found mixed results in terms of quality of care provided to Medicare and Medicaid beneficiaries.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

Here are the top 5 articles for the month of August.

A new government analysis revealed that despite a previous warning, CMS failed to take steps to ensure that Medicare Part D does not also pay for drugs that should be covered under the Part A hospice benefit; with studies of antidepressants’ safety and efficacy only following patients for a few years and with more people taking antidepressants for longer periods of time, health professionals are concerned that some people taking the drugs for extended periods shouldn’t be and are thus subjecting themselves to side effects and potential health risks; Medicaid advocates in Nebraska have filed a lawsuit to try and force the state to implement Medicaid expansion no later than November 17, 2019.

Medicare Shared Savings Program accountable care organization (ACO) network comprehensiveness is associated with stable patient assignment year to year. Panel stability was significantly associated with improved diabetes and hypertension control in the short term.

Authors from Facing Our Risk of Cancer Empowered (FORCE), a nonprofit organization focused on hereditary cancer, discuss the importance of genetic testing, guidelines, and coverage considerations.

A class-action trial begins Monday in Hartford, Connecticut seeking to end Medicare regulations around something called “observation care” in the hospital; California hospitals are providing significantly less free and discounted care to low-income patients because the Affordable Care Act reduced the number of uninsured patients; The American Academy of Pediatrics released its first policy statement about how racism affects the health and development of children and adolescents.

The FDA ordered 4 companies to stop selling 44 of their flavored e-liquid and hookah tobacco products that lack the required approval for sale; CMS has yet to implement a 2014 law preventing unnecessary, expensive screening tests (magnetic resonance imaging, computed tomagraphy scans and other tests) that could harm patients and waste resources; Amarin, which is seeking FDA approval for an expansion of Vascepa labeling to include data that showed a 25% reduction in the risk of heart attacks and strokes, said the FDA has scheduled an advisory committee meeting for November 14.

In a long-awaited national coverage determination decision, CMS said Wednesday that it approved chimeric antigen receptor (CAR) T-cell therapies for Medicare beneficiaries nationwide.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Hospices will receive a $520 million increase in payments from CMS in fiscal year 2020; urban areas accounted for more drug overdose deaths rates than rural areas in 2016 and 2017; a federal judge has ruled that a lawsuit against a California price transparency law can proceed.

This week, the top managed care news included HHS laying out a plan for importing certain prescription drugs from other countries; a potential new standard of care for chronic lymphocytic leukemia; 3 insulin makers get subpoenaed over their pricing practices.

Low- and middle- income Medicare beneficiaries face increasing financial burden as employer coverage erodes.

Tuesday's Democratic presidential debate, the first of 2 days, included disagreements over the viability of Medicare for All; 3 insulin makers received subpoenas from the New York Attorney General over their pricing practices; US News & Report released its 30th Annual Best Hospitals rankings.

CMS announced changes to make it easier for the consumer to know what they are paying for in healthcare and for physicians to manage chronic conditions.

CMS said it is piloting the integration of Medicare historical claims data into electronic health records to give physicians more information about their patients at the time of an office visit.

This past week saw several pieces of legislation introduced to lower the cost of prescription drug prices. Here are 5 ways patients and providers would be affected by the bills.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

A new report from the HHS’ Office of the Inspector General praises 20 high-performing accountable care organizations (ACOs) for the strategies they are using in the shift to value-based care.

President Trump is preparing an executive order that would slash prices on nearly all drugs sold to Medicare; Allergan has recalled certain breast implants following 573 cases of implant-associated anaplastic large cell lymphoma; a study has found 1 in 4 people intend to use antibiotics without a prescription.

Spearheaded by Senate Finance Committee Chairman Chuck Grassley, R-Iowa, and Ranking Member Ron Wyden, D-Oregon, the bipartisan bill would lower out-of-pocket (OOP) costs for Medicare and Medicaid beneficiaries and save the government billions.

The bill would reduce prices up to 75% based on anticipated 2020 levels, according to Senator Jeanne Shaheen, D-NH, the lead sponsor.

Depending on how ready accountable care organizations (ACOs) are to move to risk probably affects how they view CMS’ decision to transition the Medicare Shared Savings Program (MSSP) to Pathways to Success, said Travis Broome, vice president of policy at Aledade.

As the fate of the Affordable Care Act (ACA) remains uncertain, 21 million people are at risk of losing their health insurance. In addition to large coverage gains as a result of the ACA, the law resulted in various other sweeping changes to the US healthcare system. Here are 5 things that would be impacted if the ACA is overturned.

Two reports from the Office of Inspector General (OIG) in HHS have identified deficiencies in the quality of care at hospices and the harm done to beneficiaries as a result of poor care or cases of abuse.