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
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…
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…
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,…
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…
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…