Hospitals can bring their case on disproportionate share hospital payments to the Supreme Court
The Supreme Court granted hospitals’ request that it hear their appeal about the formula for determining Medicare disproportionate share hospital (DSH) payments, landing the case on the docket for the 2024-25 term. More than 200 hospitals are plaintiffs in the case. A federal district court ruled for HHS and against the hospitals in 2022, and…
Health system CEO tells Congress proposed 340B changes would be harmful to organizations like his
A health system executive visited Capitol Hill recently to provide the hospital perspective on the 340B Drug Pricing Program — a viewpoint that increasingly is coming under fire among policymakers. Matthew Perry, president and CEO of Genesis HealthCare System in Zanesville, Ohio, appeared at a House subcommittee hearing June 4 to give insight on why…
For providers, application of the 2-midnight rule to Medicare Advantage appears to bring a revenue influx
Hospitals appear to have gained a significant, albeit likely short-term, revenue boost from CMS’s 2023 directive to Medicare Advantage (MA) health plans regarding the two-midnight rule. The rule first was instituted in 2013 for Medicare fee-for-service (FFS), requiring the program to cover hospital stays as inpatient admissions if the admitting physician expects the stay to…
Ken Perez: How 3 presidential candidates are defining their prescription drug pricing policies
What do voters care most about? It’s arguably the most salient question in every election cycle. Each March, to answer that question, Gallup asks Americans to rate their concern about a variety of national issues. This year’s survey asked respondents about 14 different issues.a Inflation came out on top, with 55% of those surveyed worrying…
The key role of downside risk in the success of value-based care
The basic idea behind value-based care (VBC) is simple. By encouraging providers to focus on the value rather than the volume of the services they deliver, it should be possible to achieve the twin goals of lowering healthcare costs and improving clinical outcomes. Given that the United States now spends far more per capita on…
A new DOJ task force is the latest example of intensified federal oversight of healthcare antitrust issues
A new task force at the U.S. Department of Justice (DOJ) is likely to bring additional scrutiny on whether healthcare transactions adversely affect competition. The department’s Antitrust Division announced the formation of a group to “consider widespread competition concerns shared by patients, healthcare professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor…
340B providers are at a disadvantage after the latest court ruling on contract pharmacies
A decision issued by an appeals court represents the latest setback for 340B providers hoping to secure widespread access to price discounts on Medicare Part B drugs. The U.S. Court of Appeals for the District of Columbia Circuit on May 21 upheld a district-court ruling that drug manufacturers can impose restrictions on the 340B discounts…
David Johnson: Site-neutral payment and the battle for healthcare’s soul
In a remarkable and surprising show of bipartisanship, the U.S. House of Representatives passed the Lower Costs, More Transparency Act on Dec. 11, 2023, by an overwhelming 320-71 vote. Avoiding hyperbole, the act lives up to its name. It seeks to equalize Medicare payment for the same drugs administered in the same way, whether in…
Hospital payments have been substantially affected by the Change Healthcare cyberattack, report finds
Newly published data reflect the extent of the payment loss experienced by hospitals and health systems during the first month or so after the Change Healthcare cyberattack. A report (registration required) published in mid-May by Strata finds that gaps in expected revenue ranged from 16.5% to 17.9% per hospital for Q1. The insights were culled…
HHS issues regulations to strengthen anti-discriminatory protections in healthcare (updated)
July 3 update A judge with the Southern District of Mississippi federal court granted an injunction preventing the Biden administration from enforcing regulations expanding anti-discrimination protections in the Affordable Care Act (ACA). Issued two days before the new rule was to take effect, the order applies to the provisions concerning gender identity. The move came…