Healthcare Finance News

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…

Nick Hut October 7, 2024

Supply chain challenges could mount for hospitals amid extensive hurricane damage to a key facility

Note: This article was updated Oct. 7 with urgent recommendations from the American Hospital Association to address the product shortage. See the update below. The supply chain for hospitals and other healthcare providers has taken a hit from the intense destruction wrought by Hurricane Helene. In causing substantial destruction to parts of Florida, Georgia, the…

Nick Hut October 3, 2024

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.,…

Nick Hut September 27, 2024

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…

Nick Hut September 23, 2024

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…

Nick Hut September 21, 2024

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…

Nick Hut September 17, 2024

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…

Nick Hut September 12, 2024

New federal rule means big changes in coverage of behavioral healthcare

Landmark regulations issued by the Biden administration are intended to establish coverage parity for behavioral healthcare services. A newly published final rule prohibits group health plans, along with health insurers offering group or individual insurance coverage, from restricting access to mental-health and substance-use disorder (SUD) benefits as compared with medical and surgical benefits. The rule,…

Nick Hut September 10, 2024

Medicare administrative contractor news includes a data breach and potential consolidation

Recent happenings involving Medicare administrative contractors (MACs) include a notice of a data breach and a request for feedback on possible consolidation. CMS sent out word that nearly 950,000 Medicare beneficiaries whose claims go through Wisconsin Physicians Service Insurance Corporation (WPS) are being informed that their protected health information or other personally identifiable information may…

Nick Hut September 9, 2024

HHS concedes defeat in litigation over providers’ use of tracking technologies on websites

The hospital lobby cemented its victory in litigation about online tracking tools after HHS canceled its planned appeal. In June, the American Hospital Association (AHA) and co-plaintiffs won a decision in a Texas federal court about 2022 guidance (revised and somewhat softened in 2024) instructing hospitals and other HIPAA-covered entities to avoid using online tracking…

Nick Hut September 6, 2024
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