Insurer Data Requests Prompt Hospital Policy Overhauls
March 12—As health insurers increasingly get involved in patient care management, they are requesting clinical data on individual patients from hospitals and health systems.
What Anthem’s Imaging Policy Means for Hospitals
Hospitals that own outpatient imaging departments should not ignore the significance of Anthem’s new imaging site-of-care policy.
Did Prices Drive Recent Healthcare Spending?
Jan. 30—Healthcare prices were cited as the driver of the recent surge in healthcare spending, but that conclusion may be missing the whole picture, according to some researchers.
Overcoming Common Obstacles of Transitioning to Electronic Insurer-to-Provider Payments
A Pennsylvania health plan worked with providers to implement electronic payments and eliminate the issues of paper checks.
Hospital Spending Growth Slows in 2017
Jan. 22—Hospital spending grew less than half as fast in 2017 as it did the year before, according to a recent economic trends analysis.
Of Noise and Signal: Why Bundled Payment Keeps Moving Forward
CMS has not moved decisively in developing bundled-payment, episode-of-care payment models, leaving states and health plans to lead the way with innovative approaches.
Trend Toward Increasing Payer Deductions Continues
Payer deductions continue to increase, with government payers far exceeding private and managed care plans.
How CMS Leveled the Playing Field for Hospital Readmission Penalties
A new rule finalized by CMS acknowledges that charging hospitals with higher percentages of dual eligibles the same readmission penalties as hospitals with fewer of these patients. The proposed penalty adjustment will reflect the challenges facing each hospital's populations.
Why Horizon BCBSNJ Likes Episode-of-Care Payments
Horizon Blue Cross Blue Shield of New Jersey’s episode-of-care program, believed to be the largest such program in the country, rewards physicians for successes but does not subject them to penalties. Horizon says that this arrangement creates better foundations for payer/provider relationships to move toward shared risk over time.
The Move to Office-Based Services Not Yet Showing Impact
Although commercial health plans have tried to equalize payments between hospital and office-based settings, hospital payments still remain higher and share of procedures by site have remained consistent.