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CMS finalizes MA payment bump, risk-adjustment changes for 2020

April 2, 2019

CMS on Monday finalized payment and policy changes for Medicare Advantage and Medicare Part D plans for the 2020 coverage year.

Most children's hospitals can avoid the value-based care revolution. So why is this hospital taking the plunge?

April 1, 2019

Although value-based care models are optional for children's hospitals, Dayton Children's Hospital is choosing to take on value-based financial risk.

Centene to purchase WellCare in $15.3B deal, forming a Medicare, Medicaid 'powerhouse'

March 29, 2019

Centene this week announced that it will buy WellCare Health Plans for $15.3 billion—a move that will increase Centene's Medicare Advantage business and further solidify the insurer as the biggest insurer of Medicaid managed care plans.

CMS proposes significant changes to TAVR program requirements. Here's what you should know.

March 28, 2019

CMS on Tuesday proposed a set of policies that would make it easier for providers to meet surgical volume requirements to launch a transcatheter aortic valve replacement program and receive Medicare and Medicaid reimbursement for the procedure.

EConsults are becoming more popular in health care, but there's still some unknowns

March 28, 2019

A growing number of primary care doctors are replacing in-person specialist consults with electronic consultations—a practice that can "free up capacity in crowded health systems" and reduce wait times for other patients, according to health economist Austin Frakt.

Inside House Democrats' bill to bolster the ACA

March 27, 2019

House Democrats on Tuesday released a draft legislative package intended to strengthen the Affordable Care Act's exchange market by implementing a federal reinsurance program, scaling back short-term health plans, and more.

The entire ACA should be struck down, DOJ argues in 'stunning' reversal

March 26, 2019

The Department of Justice in a legal filing Monday said a federal appeals court should strike down the entire Affordable Care Act as unconstitutional, changing its previous position that the court should only strike down parts of the law.

Clinician participation in MACRA's QPP exceeded CMS' goals, new report shows

March 25, 2019

The number of clinicians who participated in MACRA's Quality Payment Program in 2017 exceeded CMS' initial goal, according to a report the agency released Wednesday.

More than 200 providers have withdrawn from BPCI model—but experts aren't worried

March 22, 2019

CMS on Thursday announced that the number of hospitals and physician groups participating in Medicare’s new voluntary bundled-payment model declined by 16% over the program’s first five months.

HHS' drug rebate proposal already has drawn 18,000 comments—but there's a catch

March 22, 2019

HHS has received about 18,000 comments on its proposal to overhaul the U.S. drug rebate system—and many of the largest industry stakeholders have yet to weigh in.

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