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Hospital-acquired conditions cost a lot money—and lives—in 2016, research finds

October 25, 2018

A research brief from IBM Watson Health shows 48,771 hospital-acquired conditions occurred in 2016, which resulted in billions of dollars in excess hospital costs and thousands of potentially avoidable deaths.

Paying physicians to boost screenings isn't an illegal kickback, HHS' OIG suggests

October 25, 2018

A Medicaid managed care insurer can pay doctors bonuses to increase preventive screenings and it will not be considered kickback, according to an advisory opinion from HHS' Office of Inspector General.

Are Medicaid managed care plans saving states money? Some regulators raise doubts.

October 22, 2018

The number of U.S. residents enrolled in Medicaid managed care plan has grown to more than 54 million, but experts say the federal and state governments have not been properly monitoring the plans.

What providers like—and don't like—about CMS' proposal to overhaul MSSP

October 22, 2018

A few health care providers say they support some provisions of CMS' proposed rule to overhaul the Medicare Shared Savings Program, but many providers are voicing concerns.

Another insurer prevails in lawsuit seeking cost-sharing reduction payments

October 19, 2018

A federal claims court judge last week ordered CMS to pay Sanford Health Plans about $360,000 in cost-sharing adjustment payments called for under the Affordable Care Act, giving insurers another win in cases contesting the Trump administration's decision to cut off the payments.

The 5 fears that keep doctors up at night

October 17, 2018

From politics to financial concerns, Robert Pearl, a surgeon and former CEO of the Permanente Medical Group, in a Forbes article breaks down the "five intense fears" plaguing doctors today.

New BPCI model launches with 1.3K participants. How are providers feeling about it?

October 10, 2018

CMS' Bundled Payments for Care Improvement-Advanced Model launched Monday with 1,299 participating entities, and while some participants are excited about the model's prospects, others already are contemplating leaving the model.

Judge orders CMS to pay $1.2M in cost-sharing reduction payments to co-op

October 9, 2018

A federal claims court judge who last month ruled that the Trump administration erred in its decision not to pay insurers cost-sharing reduction (CSR) payments is now ordering CMS to pay Montana Health co-op more than $1.2 million in CSR payments.

What Kavanaugh's confirmation means for SCOTUS' health care rulings

October 8, 2018

Supreme Court Justice Brett Kavanaugh has ruled on several high-profile health care cases that some observers say could shed light on how he would rule if cases on those issues were to reach the Supreme Court.

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