Policy and Legislation
CMS has just released a proposed rule that would require Medicare prior authorization for certain Medicare Durable Medical Equipment items that the agency characterizes as "frequently subject to unnecessary utilization." The decisions would not be subject to appeal.
Medicare may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing the controversial two-midnight rule that tells hospitals when patients should be admitted, according to an independent Medicare auditing company.
If global spending becomes the norm in Medicaid, health systems, medical practices, home health and community organizations will face an even greater impetus to collaborate. In the Empire State, some are already starting the journey.
Powerful social forces will drive the healthcare industry to innovate, overcoming institutional and political inertia, says healthcare consultant and futurist Ian Morrison. But things may not get 'serious' until 2018.
While a referral arrangement reversal has upset the applecart for some, most providers are taking it in stride.
Late last week, the Health Resources and Services Administration released the results of its FY 2012 audits of covered entity compliance with 340B drug discount program rules. The agency discovered several "recurring critical areas of non-compliance" for healthcare facilities.
Twenty-four states, including almost the whole South, took the stubborn path and have so far refused to expand Medicaid. That's a big reason rural hospitals are continuing to struggle.
A new Medicare prospective payment system for federally qualified health centers offers improved reimbursement rates.
The latest data from the Bureau of Economic Analysis estimate that spending for healthcare services jumped by about $50 billion in the first quarter of 2014 compared to fourth quarter of 2013. But don't listen to those who say we are on track for a 10 percent rise in health spending over the full year.
Although they're not expanding Medicaid under the Affordable Care Act, Texas, Florida and other states are expanding managed care, bringing insurers opportunities as well as challenges, including competition from provider-based health plans.