A National Quality Forum (NQF) panel commissioned to study quality and risk adjustment for socioeconomic status suggests that hospitals treating a large number of poor people face significant disadvantages in achieving the high quality necessary for payment under pay for performance. Because Medicare and other payers either are or will be paying hospitals and […]
The controversial “two-midnight” rule has activated a group of hospitals and hospital associations to challenge it by filing two related lawsuits in the U.S. District Court for the District of Columbia. The plaintiffs take issue with the “wholly arbitrary” requirement that a physician must certify at the time of admission that a Medicare patient is […]
Competition continues to be on the priority agenda for the Federal Trade Commission (FTC). It recently hosted a workshop to gain input from healthcare industry experts about the degree to which promoting healthcare competition is integral to improving quality, lowering costs and expanding access. The FTC’s focus on competition isn’t new—it devoted a lot […]
We have written several newsletters on the impact of the two-midnight rule for hospitals. Now Moody’s Investors Service offers five observations that specify how and why this rule will negatively affect a hospital’s revenue. (Two-Midnight Rule Will Reduce Revenue for Most Hospitals, Sector Comment, Moody’s Investors Service, March 12, 2014) The two-midnight rule classifies […]
The Affordable Care Act’s health exchanges have been overwhelmed with last minute sign ups, and the results so far indicate more than seven million enrollees. How this “new” market of insured customers will affect hospitals is the subject of a recent report from Moody’s Investors Service. Highlights from the report appear below. There are […]
Stock prices for large publicly traded insurance companies have risen in recent weeks, signaling investors confidence that health reform will improve insurance companies’ bottom lines despite dire warnings from the industry itself. America’s Health Insurance Plans, the industry’s trade group, has been predicting a troubling if not catastrophic outlook for insurance companies. It cited […]
The administration’s fiscal year 2015 budget proposal details more than $400 billion in cuts to Medicare, Medicaid and other federal health spending over the next 10 years. Medicare provider payments would be cut $3.5 billion; $1.5 billion of those payment cuts would come from post-acute providers and $960 million from graduate medical education (GME). […]
The HHS Office of Inspector General (OIG) released its annual report on healthcare fraud and abuse last week. According to the report, 71 hospitals and health systems paid $163.4 million to settle healthcare fraud allegations in FY 2013. Some of the more notable results included: Winning or negotiating more than $2.6 billion in healthcare […]
A bipartisan group of more than 100 representatives from the House wrote Kathleen Sibelius, Director of the Department of Health and Human Services (HHS) last week to express their concerns with the Recovery Audit Contractor (RAC) program and strongly urged reform of the RAC process. The letter noted operational problems in the RAC program and […]
Last week we reported on a new report that found no conclusive relationship between hospital consolidation and price increases in a community. There is a new wrinkle, however. A hospital or system merger with a large physician group practice may not pass the competition/price increase test. In Idaho last month, a district judge sided with […]