Research seeks to pinpoint health system characteristics associated with the tendency to ‘overuse’ healthcare
Higher bed counts, fewer primary care physicians and investor ownership are among the characteristics of health systems that tend to overuse healthcare, according to a new study.
Coverage denials based on medical necessity are far more likely to arise from Medicare FFS rules than from MA plan policies
Coverage rules stemming from Medicare national and local determinations were the most likely cause of claim denials in one Medicare Advantage plan.
CMS proposes to restrict Medicare coverage of a high-profile new Alzheimer’s drug
Medicare will pay for use of a new drug to treat Alzheimer’s disease only for patients in approved clinical trials, CMS said in a proposed coverage determination.
Accelerated drug approvals present a mounting challenge to oncologists and raises concerns about cost effectiveness for health system finance leaders
In the past year, Americans have witnessed two extremes of the FDA’s accelerated approval process, exposing both profound strengths and worrisome weaknesses. Finance leaders should keep informed about new drug treatment options, their associated costs and efficacy and whether lower-cost alternatives that have the same efficacy are available so they can engage in meaningful conversations with clinicians about which options truly promote cost effectiveness of health.
Payvider Survey Summary Report
HFMA, with sponsorship from Guidehouse, surveyed over 100 health system CFOs and finance and managed care executives to understand payvider model trends. The survey indicates that provider organizations are gravitating towards risk-based payment models. Nearly 60% of health systems responding to the survey plan to advance into risk-based Medicare Advantage models this year. Survey respondents…
New surprise billing regulations: Assessing a patient’s network status will be a key challenge
With new surprise billing regulations in place, providers should seek to implement efficient processes for gauging whether a patient is in-network.
CMS now says hospitals in half the country must abide by the COVID-19 vaccine mandate starting in late January
The status of the COVID-19 vaccine mandate for healthcare workers took another twist, with CMS stating it will look to enforce the mandate within a month in 25 states and Washington, D.C.
A White House plan to combat the omicron variant includes support for hospitals
The Biden administration announced several provisions to bolster hospitals as efforts to contain the COVID-19 pandemic enter a third calendar year.
How to create an employer-friendly healthcare center of excellence
Increasing health expenditures and the pressures of the recent pandemic have contributed to the development of a new type of center of excellence (COE), called the future-state COE, which is designed to better address the needs of large employers. This COE model incorporates value-based contracting and a strong incentive design into a service-line strategy to create employee health programs that benefit employers, patients and providers alike.
Key takeaways from HFMA’s latest Outlook Survey: Healthcare finance professionals anticipate technology-driven changes
HFMA’s most recent Outlook Survey of healthcare finance professionals highlights the potential of technology to usher in big changes in upcoming years.