A closer look: The top five American Health Line Analyses & Insights of 2018

Topics: Costs and Prices, Payments and Reimbursement, Finance, Care Models, Providers, Hospitals

American Health Line's editors and writers covered some big topics this year, including Medicare's 340B drug discount program pricing controversy, a major leadership departure at Mayo Clinic, and the year-one results from MACRA's Quality Payment Program.

Below, we round up American Health Line's top five must-read Analysis & Insight pieces of 2018.

1) The 340B drug pricing controversy, explainedFebruary 1

The controversy over Medicare's 340B drug discount program escalated late last year when CMS proposed major reimbursement cuts, including $1.6 billion in 2018 alone, and health care organizations countered with a lawsuit claiming the agency is jeopardizing patients' health. American Health Line explains what you should know about the 340B program: how it works, who it serves, why it's controversial, and what reimbursement cuts could mean for providers.

Since our story ran... CMS has moved forward with the planned 2018 cuts, and in November, finalized a rule that extends the 2018 340B drug reimbursement cut to non-excepted, off-campus hospital departments that are paid under the physician fee schedule in 2019. Health care organizations in November resumed their legal fight to halt the cuts, after the U.S. District Court for the District of Columbia dismissed their original lawsuit. The court had ruled the lawsuit was premature because the hospitals had not yet filed claims with CMS. That ruling was upheld by an appeals court in July.

2) Hospital ratings, decodedApril 13

Hospital ratings gets lots of buzz in the news, but do you know what factors actually determine a hospital's rank? American Health Line dove into four of the most popular lists—from U.S. News & World Report, Leapfrog, and more—to find out how they work and why they're so controversial.

Since our story ran... several of the leading hospital rating organizations have issued new lists. CMS in October updated its Hospital Compare data, which showed 112 hospitals earned five-star ratings, 121 received a one-star rating, and 3,460 received either a two-, three-, or four-star rating. That same month, the Leapfrog Group announced it will begin rating ambulatory surgery centers and hospital outpatient departments on patient safety and treatment outcomes in 2019. The following month, Leapfrog awarded 855 hospitals an "A" on safety, but gave more than 1,000 a "C" or below. U.S. News in August unveiled its Best Hospitals rankings, with Mayo Clinic topping the publication's "Honor Roll" for the third year in a row.

3) Exclusive: Mayo Clinic CEO on why he's stepping down, Mayo's future, and moreFebruary 21

A day after announcing he will step down as Mayo Clinic's president and CEO at the end of 2018, John Noseworthy spoke with American Health Line about his nine-year tenure as chief executive, his approach to leading through change, and his advice for the Clinic's next leader.

Since our story ran... Noseworthy has continued to lead the Clinic, overseeing the launch of new initiatives, including a partnership with health insurer Medica to develop insurance policies that will allow patients throughout the country to receive complex care at Mayo Clinic. While Noseworthy largely has remained mum on his plans for next year, the Mayo Clinic Board of Trustees in August announced Gianrico Farrugia, the vice president of Mayo Clinic and CEO of Mayo Clinic in Florida, will succeed Noseworthy as president and CEO of the Clinic in January 2019. To learn more about Farrugia and the three biggest challenges he will take on when he assumes the role, read our exclusive Q&A with Farrugia and Noseworthy.

4) MACRA made simple. (Really.)March 1

If you've followed the twists and turns in Medicare's latest changes to provider payments, you know that news coverage tends to devolve into alphabet soup: "CMS last year released a final rule for MACRA's QPP in 2018, with details on the MIPS and Advanced APM tracks." Confused yet? Don't worry—here's American Health Line's rundown of what you really need to know about MACRA's Quality Payment Program.

Since our story ran... CMS published results for MACRA's Merit-based Incentive Payment System (MIPS) for the 2017 performance year, which marked the first year of the program. CMS data showed 93% of the 1,057,824 clinicians eligible to participate in MIPS will receive a positive payment adjustment in 2019, 2% will receive a neutral payment adjustment, and 5% will see a negative adjustment. However, CMS officials projected the number of MIPS-eligible clinicians who receive a positive payment adjustment will decline in future years as the agency increases performance thresholds. For example, clinicians in the 2017 performance year were not graded on how well they manage costs, but in 2018 cost-related measures will account for 10% of their overall score. That percentage will increase to 15% in 2019, with weights for quality measures declining by equal amounts.

5) How Trump can (and can't) change health care via waiversSeptember 7

Even though the GOP fell short in its efforts to repeal and replace the Affordable Care Act (ACA) last year, the Trump administration remains dedicated to reforming health care through state-based waivers. American Health Line breaks down the three most significant ways the White House could change health care via waivers—and explains the limits of waiver authority.

Since our story ran... a lot has changed. CMS in October announced that the ACA's state innovation waivers will be renamed State Relief and Empowerment Waivers. The agency also plans to give states new flexibilities to use the waivers to change how they administer ACA premium subsidies, allow resident to use federal subsidies, and implement reinsurance programs and other risk-stabilization strategies.