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CMS will allow MA plans to implement step-therapy requirements for Part B drugs

August 13, 2018


Under a new CMS policy, Medicare Advantage plans beginning Jan. 1, 2019, will be able to implement step-therapy requirements for prescription drugs administered to beneficiaries at physician offices or hospitals—and President Trump says his administration soon will announce more policies intended to lower prescription drug prices.

This doctor wants to offer MRIs for as low as $500—but a state law is stopping him

August 3, 2018


After discovering an MRI would cost $1,200, Gajendra Singh, a gastroenterologist, decided to open his own imaging center in Winston-Salem, North Carolina, with MRI prices as low as $500—but a state law is proving to be a major obstacle.

Patients aren't savvy health care shoppers, study finds

August 2, 2018


While price transparency tools are becoming more common, it turns out few patients are using them to shop around to find the lowest-cost, quality care—even in cases where a patient is seeking a non-emergent service, according to new research.

Sanders' 'Medicare for All' bill would cost $32.6T—and change who is footing the bill

July 31, 2018


An analysis from the Mercatus Center at George Mason University estimates that Sen. Bernie Sanders' (I-Vt.) so-called "Medicare for All" proposal would cost about $32.6 trillion in new spending over the first decade—which observers say is slightly lower than what the United States is projected to spend on health care over the next ten years under its current health care system, though the proposal would shift who pays for the costs.

CMS wants to expand site-neutral payments. Here's what that means for providers, patients.

July 31, 2018


CMS' recently proposed rule to expand site-neutral payments under Medicare, if finalized, could mean Medicare would pay providers at outpatient departments the same as providers at regular doctor's offices for identical procedures, whereas they currently could be paid different rates for the same procedure.

Young adults are more likely than older adults to have medical debt, study finds

July 27, 2018


A new study finds that although young adults spend significantly less than older adults on health care bills, they are substantially more likely to have medical debt.

CMS looks to expand site-neutral payments, 340B cuts in latest Medicare payment rule

July 26, 2018


CMS' proposed rule to update the Hospital Outpatient Prospective Payment System for calendar year 2019 would, among other changes, reduce reimbursements for clinical visits at all off-campus hospital outpatient departments to about $46.

The cost of 'defensive medicine?' About 5% of your hospital bill.

July 25, 2018


Some policymakers say "defensive medicine," in which doctors provide medically unnecessary care in an attempt to avert possible malpractice lawsuits, drives more than a quarter of all U.S. health care costs, and though a new study finds that the phenomenon is real—it also suggests that defensive medicine is not nearly as big a cost driver as some claim.

Can bundled payments lower Medicare spending? New study casts doubt.

July 24, 2018


Researchers say "[h]ospital participation in five common medical bundles under [the Bundled Payments for Care Improvement program] was not associated with significant changes in Medicare payments, clinical complexity, length of stay, emergency department use, hospital readmission, or mortality."

Why unlicensed doctors could actually benefit patients, according to a new paper

July 24, 2018


It is illegal for physicians to practice medicine without a license in the United States—but a new paper challenges the assumption that licensing requirements necessarily benefit consumers.

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