As transparency rules enter their fifth year, advanced uses gain traction
With price transparency rules becoming more entrenched in the healthcare system, applications are growing more sophisticated. “There’s this treasure trove of data out there, and a lot of interest in how it can best be leveraged to support not just consumers but also broader policy goals to improve healthcare affordability,” Sabrina Corlette, JD, co-director of…
Hospital financial and revenue cycle benchmarks paint a complicated picture heading into the new year
The tail end of 2024 has brought promising news regarding hospital financial metrics, even as revenue cycle indicators suggest continuing strain. Margin data are showing moderate improvement, and one of the three credit-rating agencies has upgraded its 2025 sector outlook for not-for-profit (NFP) hospitals and health systems. Fitch Ratings announced this week it was revising…
The state of U.S. primary care: Daunting challenges, achievable solutions
Value-focused efforts to shore up primary care require bold initiatives that increasingly are being implemented but continue to encounter obstacles, according to insights from a recent conference. “We have answers in a kind of amazing array of [physician] practices all over the country that are generally doing an aligned thing,” said Asaf Bitton, MD, associate…
Detained suspect in the killing of UnitedHealthcare CEO Brian Thompson seemed to have a grudge against the healthcare industry
The capture of a suspect in the homicide of UnitedHealthcare CEO Brian Thompson appeared to confirm the notion that anger at the healthcare industry motivated the perpetrator. A man named Luigi Mangione, 26, was apprehended at a McDonald’s in Altoona, Pa., on Monday, five days after Thompson was gunned down outside the site of parent…
Proposed ban on medical debt reporting faces an unfavorable political climate
Regulations essentially prohibiting the reporting of medical debt appear to be on shaky ground heading into 2025. Litigation brought by trade groups representing the accounts receivables industry has stalled the advancement of regulatory language issued by the Consumer Financial Protection Bureau (CFPB), and a bigger threat is impending with the upcoming transition of power in…
Motive, perpetrator remain elusive in shooting death of UnitedHealthcare CEO Brian Thompson
Media reports and law enforcement sources described Wednesday morning’s fatal shooting of UnitedHealthcare CEO Brian Thompson as a targeted attack against a high-profile executive, but as of early evening, police could not say why it happened. Thompson, 50, a married father of two teenage children, was walking toward the New York Hilton Hotel in Midtown…
2 proposed rules seek to stem insurers’ use of prior authorization, medical management
In its waning days, the Biden administration hopes to lay additional groundwork for curbing health plan policies regarding prior authorization in Medicare Advantage (MA), along with group health plan tactics that may interfere with access to certain preventive items and services. MA prior authorization criteria A proposed rule implementing 2026 policy and technical changes for…
A nearly $3 billion settlement with Blue Cross Blue Shield leaves providers with a big choice (updated)
Note: The second section of this article was updated Dec. 5 with news that the proposed settlement has been formally approved. Providers that contract with Blue Cross Blue Shield should assess whether they want to participate in a landmark class-action settlement over litigation stemming from complaints about the insurer’s business practices. In October, a resolution…
Medicare, Medicaid are set to cover GLP-1 drugs under a Biden administration proposal
In a major development for Medicare and Medicaid, the Biden administration has issued a proposal for the program to cover a class of weight-loss drugs that have become increasingly prevalent in society. A proposed rule implementing Medicare Advantage and Medicare Part D technical and policy changes for 2026 includes a provision to reinterpret statutory language…
Biden’s director of Medicaid expresses concern for the program’s future amid talk of block grants
In what amounted to a valedictory for CMS leadership as it has been constituted during the Biden administration, the head of Medicaid expressed concern about the potential for big changes to the program. Daniel Tsai, director of the Center for Medicaid and CHIP services, said the possible transformation to a block-grant program under the incoming…