Finalized appeals processes for Medicare patients will require new hospital protocols in 2025
Hospitals should prepare to imminently accommodate new appeals processes and paperwork for Medicare patients whose status gets changed from inpatient to outpatient observation during a stay. A newly published final rule gives beneficiaries options for appealing such a change. The effective date of the new appeals processes was not announced in the rule, but CMS…
Providers hope to reverse a court’s No Surprises Act ruling that would affect independent dispute resolution
Hospital and physician advocates are urging an appeals court to reverse a district court’s decision that would render No Surprises Act (NSA) arbitration payments unenforceable. In May, two air ambulance companies lost a case in a Northern District of Texas federal court in which they sought payment from Health Care Service Corporation (HCSC) for awards…
Hospital price transparency enforcement should look at pricing data quality, GAO says
In a report on federal oversight of hospital price transparency regulations, the Government Accountability Office (GAO) says CMS should expand its enforcement purview. The report rehashes many of the technical and formatting issues that stakeholders have discussed since the regulations took effect in 2021. But it goes a step further by questioning whether guardrails are…
Despite positive outcomes, coverage of GLP-1 drugs presents complicated questions
The drugs known as GLP-1 receptor agonists bring the potential for improved health to millions but also a bevy of questions and challenges concerning cost and coverage, according to insights in a recent webinar. GLP-1s such as Ozempic and Wegovy initially came to market as a way to control blood sugar for people with type…
Supply chain challenges could mount for hospitals amid extensive hurricane damage to a key facility (updated-5)
Updates Click on the dates to see updates at the bottom of this article page as follows: Oct. 21: Updates from HHS on distribution times and from FDA on drug-compounding permissions Oct. 17: The latest from Baxter on allocations and the importation of fluids from overseas Oct. 14: Baxter ramps up international production; an advisory…
New rules have program integrity implications for Medicare, Medicaid stakeholders
CMS in recent days issued a pair of final rules designed to improve aspects of program integrity in Medicare and Medicaid. The Medicare rule was published Sept. 27 and finalized proposals that were published in early July after CMS became aware of significant potential billing fraud involving a specific type of urinary catheter. Premier, Inc.,…
FTC takes legal action against pharmacy benefit managers, citing a distorted drug-pricing structure
A growing dispute between pharmacy benefit managers (PBMs) and government regulators intensified Sept. 20 when the Federal Trade Commission (FTC) filed suit against the three leading PBMs and their affiliated group purchasing organizations (GPOs). The complaint against CVS Caremark, Express Scripts, Inc. (ESI, owned by Cigna) and OptumRx (UnitedHealth Group) seeks to address a system…
Reports on healthcare labor trends indicate an improved outlook for hospitals
The labor picture continues to stabilize for hospitals even amid sustained high demand for healthcare services, according to new insights. In its latest labor tracker, Fitch Ratings reported that hospital staff payrolls have been steadily expanding and now represent a 6.7% increase relative to the pre-pandemic month of February 2020. Hospitals added 18,650 jobs per…
MedPAC starts to scrutinize the costs of outpatient coinsurance at critical access hospitals
At the nation’s nearly 1,400 critical access hospitals (CAHs), cost-sharing payments incurred by Medicare beneficiaries for outpatient services are onerous enough that a new methodology warrants consideration, according to a recent policy discussion. The Medicare Payment Advisory Commission (MedPAC) examined the issue at its September meeting, reporting that beneficiary coinsurance for CAH outpatient care equates…
Senate hearing on Steward Health Care depicts consequences of hospital management decisions (updated-2)
Note: This story was updated Sept. 26 and Sept. 30 with additional news, including a lawsuit filed by now-former CEO Ralph de la Torre. After the CEO of Steward Health Care rebuffed a subpoena to appear Thursday at a Senate committee hearing, members and invited panelists used the occasion to bemoan the company’s hospital ownership…