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Entries in Thayer, Claire (286)

Friday
Mar162018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

The Other Opioid Crisis: Hospital Shortages Lead To Patient Pain, Medical Errors

Even as opioids flood American communities and fuel widespread addiction, hospitals are facing a dangerous shortage of the powerful painkillers needed by patients in acute pain, according to doctors, pharmacists and a coalition of health groups.

Kaiser Health News

Friday, March 16, 2018

GOP support for Obamacare stabilization grows, but abortion policy still unresolved

Congressional Republicans are growing more receptive to funding an Obamacare stabilization effort in the omnibus spending bill but remain divided over abortion restrictions.

Politico

Thursday, March 15, 2018

BCBS joins with Lyft, CVS and Walgreens in new pop health effort

The Blue Cross Blue Shield Association (BCBSA), the parent company for 36 Blues companies spread across the country, has launched the Blue Cross Blue Shield Institute to address social determinants of health (SDOH) and the influence on health and outcomes.

HealthCare Dive

Thursday, March 15, 2018

SEC charges Theranos CEO with 'massive fraud'

Elizabeth Holmes, founder and CEO of the embattled blood-testing startup company Theranos, has been charged with “massive fraud,” the Securities and Exchange Commission announced Wednesday.

The Hill

Wednesday, March 14, 2018

More than 60% of healthcare orgs saw cyberattack in past year

Cybersecurity concerns continue to hound healthcare organizations, with 62% of executives reporting a cyberattack in the past year and more than half of those losing patient data, a new Ponemon Institute survey shows.

HealthCare Dive

Tuesday, March 13, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Mar092018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

A Health Plan ‘Down Payment’ Is One Way States Try Retooling Individual Mandate

As President Donald Trump and congressional Republicans tirelessly try to dismantle the Affordable Care Act, a number of states are scrambling to enact laws that safeguard its central provisions.

Kaiser Health News

Friday, March 9, 2018

US to Idaho: ‘State-based’ health plans don’t pass muster

Idaho’s move to let companies offer health insurance plans that don’t meet Affordable Care Act standards is illegal, U.S. officials said Thursday.

AP News

Friday, March 9, 2018

Cigna Bets on Getting Bigger as Rising Costs Vex Health Business

Under pressure to tame ever-increasing health-care costs, the companies that help millions of Americans manage their medical care are wagering that they can be stronger and simpler by joining forces.

Bloomberg

Thursday, March 8, 2018

Amazon Offers Discount Prime Membership to Medicaid Recipients

Amazon.com Inc said on Wednesday it was expanding its discounted Prime membership offer to Medicaid members, the U.S. government's health insurance program for the poor.

The New York Times

Wednesday, March 7, 2018

UnitedHealthcare to share drug rebates with 7M members; the Trump administration approves, says HHS' Alex Azar

UnitedHealthcare will offer drug rebates directly to some of its members, a move that comes as payers and pharmaceutical companies fight over who's to blame for rising drug prices. Beginning in 2019, UnitedHealthcare will expand its pharmacy discounts to about 7 million enrollees who are in fully insured commercial group plans, the insurer announced.

Fierce Healthcare

Tuesday, March 6, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.
 
Friday
Mar022018

Five Questions for Patrick Horine, CEO DNV GL Healthcare: Post-Webinar Interview

By Claire Thayer, March 2, 2018

This week, Patrick Horine, CEO DNV GL Healthcare, participated in a Healthcare Web Summit webinar panel discussion on Leveraging Hospital Accreditation for Continuous Quality Improvement webinar. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Patrick on five key takeaways from the webinar:

1. What is ISO 9001 and how is this closely related to strategic goals for hospitals?

Patrick Horine: Goals are just goals unless there are objectives in place to be measured and met to achieve them.   The ISO 9001 quality management system (QMS) is the means for managing the objective to determine the needs of and desires for customers.    The ISO 9001 QMS is customer focused and to ultimately enhance patient satisfaction.    Engaged employees means more patient satisfaction.   Enhance patient satisfaction increase HCAHPS scores.   Increased HCAHPS scores are what provide the financial and reputational incentives for hospitals.    Given the current challenges with reimbursement and the competitive climate it is imperative for hospitals to ensure the patient experience and satisfaction is best as it can be.  Quality objectives are at every level of the organization.  They may apply broadly across the organization or more narrowly.   The goal may be the result but there are a lot of contributors to ensure the goal is attained.    Quality objectives are specified and aligned with the goals to enable the measuring and monitor of progress to evaluate progress.

2. What are some of the benefits and challenges associated with implementing ISO 9001?

Patrick Horine: In short, I would note the following:

  • Improving consistency
  • Added accountability
  • Increasing efficiency
  • Engagement of Staff

What drove us to consider integrating this within the accreditation process was because the hospitals we were working with could make improvements or address compliance but they had a more difficult time sustaining what they put in place.    ISO 9001 requires such things as internal auditing and management review are two of the most impactful aspects for the ISO 9001 requirements.  

Through these internal audits and then reflecting the success of the actions taken with the management reviews will lead to more consistent practices through the organization.   It is not uncommon see multiple versions of similar policies all throughout the hospital.  Are they really different?   Likely not, so reducing these to one practice will improve consistency.    I often ask groups “How many of you think you follow your policies and procedures exactly as they are written?”   Rarely, if ever, would you see anyone state they did.   So, if we don’t then why do we have them?   If we need to have them, as we really do, then they should be written, communicate, implemented and measured to ensure they are being consistently followed.   Without fail, doing so will lead to better results in some manner.

Simplification and consistent processes lead to more efficient operations of the hospital.   Hospitals or any organization for that matter that considers the quality management to be an integral part of their business operations will commonly achieve more efficiency than those that do not.

Gaining this understanding of the processes and getting to the efficiency is not possible without the involvement of those closest to them.    As an organization, if we strive to improve every day, it is imperative that the staff are engaged so they can be directly involved to improve their work to be more satisfied with what they do and their contribution to the success of the organization.   

Happy wife = Happy life, the same holds true with Happy employees = Happier patients.    Those who are more involved with improving of the processes they work with are happier and more engaged employees. Engaged employees are more productive when they are identifying improvements to be made and how to go about making them.  

Challenges

  • Culture not conducive to change
  • Making it more complicated than it needs to be
  • Too many details

Can an organization implement ISO 9001 overnight?  No.   This is something that will leadership commitment, engagement of staff, willingness to be self-critical, ability to break with traditional thinking.    More easily described, the culture of the organization must be such that you are open to change, making improvements and have patience to know the quality management system will mature over time.   

What seems to be more universal thinking among us healthcare people, if it is not difficult then we will find a way to make it so somehow.    In my opinion, I think the ISO 9001 standard has evolved with each revision to be more and more befitting to healthcare than other industry sectors.    Process thinking, sequence and interactions, risk-based, competence of staff, customer expectations and satisfaction.   It fits.   We have much of what ISO requires already in place but still some work to be done.   This does not require wholesale changes so we don’t have to make it more difficult.   What is working and what is not working is a critical step because we must understand where improvements or change need to be made.  

Like I mentioned, policies and procedures are rarely followed exactly as they are written, but some are written as works of literature with elaborate detail.   Simplify, a 30-page policy is more effective when adapted to a 2-page work instruction.   More likely that one would read it, better opportunity for it to be consistently applied.    That is not to say that some we rid ourselves of all policies and procedures but rather don’t add complexity to what we already have and ask what we need to really keep.   

3. How does ISO 9001 hold hospitals accountable for meeting CMS requirements?

Patrick Horine: ISO 9001 itself does not address the CMS Conditions of Participation (CoPs).    All hospitals are accountable for compliance if they want to bill and be reimbursed under Medicare & Medicaid.   All CMS approved accreditation organizations must develop standards that meet or exceed the CMS CoPs.  Some choose to have more extraneous requirements, others apply the minimum.   DNV GL Healthcare wanted to have a standard that would meet the CoPs but we have integrated the ISO 9001 to the accreditation process and made this a requirement for hospitals under our program.  Compliance to the CMS requirements should be the by-product of a good quality management system and this is where ISO 9001 can be most effective. 

The ISO 9001 helps organizations have a more robust quality management system in place where compliance should be more of a by-product then the end goal.   Our thinking was that hospitals are often not complying with the minimum requirements to be met and these are what are fundamental to the organization to have provide safe and effective care.    To be more consistent meeting the fundamental requirements is the first challenge.   Going beyond, rather than more prescriptive requirements, the CoPs can be the parameters and the organization can me innovative to put practices in place.  We can still hold the hospital accountable meeting the CoP and then see how they demonstrate the effectiveness and outcomes of what they have in place.  

4. While the accreditation process for hospitals is part of Medicare / CMS program requirements, are there any plans to accredit hospital labs, physician clinics, or long term care organizations?

Patrick Horine: We currently have CMS deeming authority for acute care and critical access hospitals.   Next, we will complete the process for securing deeming authority for Psychiatric Hospitals and then Ambulatory Surgery Centers.   Most likely will not purse approval under CLIA for laboratories, but always possible.   There is desire to be more certification programs with physician/medical clinics and other providers.   Presently these would be self-governed as there is no deeming authority for such medical offices nor long term care.   I believe additional quality measures and oversight would make an impact in these environments.

5. How is DNV GL different from the Joint Commission and are there other accrediting organizations?

Patrick Horine: The more evident differences would be:

  • Annual surveys vs. once every 3 years
  • Less prescriptive standard more closely aligned to the CoPs – but inclusive of some additional requirements as well as maintaining compliance with ISO 9001
  • Demeanor of our surveyors
  • No types of accreditation; preliminary denial, conditional accreditation, double secret probation

It is better to describe those differences as told to us by those we have accredited, so I will use some of their quotes;

 “With DNV GL the surveys have been more meaningful and more consistent”

  • “It is nice get away from an inspection oriented approach but still be thorough”
  • “DNV GL is not easy but is easier to get along with”
  • “We have appreciated more of a collaborative process rather disciplinary one”
  • “We want to learn from the surveyors and how we can do better”
  • “The annual surveys help keep us focused on compliance and we do less getting ready for surveys”

“Doing things for the right reason not because of … have to”

Friday
Mar022018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, March 2, 2018

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Congress Races The Clock In Quest To Bring Stability To Individual Insurance Market

Congress is running out of time if members want to come up with legislation to stabilize the individual insurance market.

Kaiser Health News
Friday, March 2, 2018

Sessions to DEA: Evaluate opioid production quota

Attorney General Jeff Sessions is asking the Drug Enforcement Administration (DEA) to evaluate whether changes are needed to the amount of opioids drug makers are allowed to produce.

The Hill
Thursday, March 1, 2018

Collective Health Bets Employers Are Fed Up With Health Expenses

Collective Health Inc., a startup offering tech-savvy tools for managing health benefits, has raised a fresh infusion of investor cash as it seeks to win over more employers fed up with a fragmented, costly market

Bloomberg
Wednesday, February 28, 2018

Apple is launching medical clinics to deliver the 'world's best health care experience' to its employees

Apple is launching a group of health clinics called AC Wellness for its employees and their families this spring, according to several sources familiar with the company's plans.

CNBC
Tuesday, February 27, 2018

Senators unveil bipartisan bill to fight opioid epidemic

A bipartisan group of senators is introducing legislation Tuesday to address the opioid epidemic, framing it as a follow-up bill to the Comprehensive Addiction and Recovery Act (CARA) signed into law in 2016.

The Hill
Tuesday, February 27, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday
Feb232018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Ten ERs In Colorado Tried To Curtail Opioids And Did Better Than Expected

One of the most common reasons patients head to an emergency room is pain. In response, doctors may try something simple at first, like ibuprofen or acetaminophen. If that wasn’t effective, the second line of defense has been the big guns.

Kaiser Health News

Friday, February 23, 2018

Evaluations Of Medicaid Experiments By States, CMS Are Weak, GAO Says

With federal spending on Medicaid experiments soaring in recent years, a congressional watchdog said state and federal governments fail to adequately evaluate if the efforts improve care and save money.

Kaiser Health News

Friday, February 23, 2018

HHS deletes budget request for $11.5 billion in risk-corridor funding

The HHS walked back a request for more than $11.5 billion to fund the Affordable Care Act's risk-corridor program after health insurers suing for those payments said the budget item strengthened their cases.

Modern Healthcare

Thursday, February 22, 2018

Advocacy groups say better data sharing, consistent privacy laws will help control opioid prescribing

A wide array of technology can help limit the impact of the opioid epidemic, according to the College of Healthcare Information Management Executives (CHIME), but only if certain policy changes address long-standing concerns like patient matching and telehealth reimbursement.

Fierce Healthcare

Wednesday, February 21, 2018

Trump proposal boosts skimpy insurance plans, again undercutting Obamacare

The Trump administration is proposing to expand the availability of short-term health insurance plans that some deride as “junk insurance” — an effort that could give consumers cheaper coverage options but undermine Obamacare's marketplaces and popular protections for pre-existing medical conditions.

Politico

Tuesday, February 20, 2018

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Feb162018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Trump health chief supports CDC research on gun violence

Secretary of Health and Human Services Alex Azar said Thursday that he would allow his department to conduct research into the causes of gun violence, a major Democratic priority.

The Hill

Friday, February 16, 2018

HHS May Nix Reporting Requirements for Value-Based Care Program, Azar Says

Health and Human Services Secretary Alex Azar told the Senate Finance Committee Thursday that he wants to reduce or possibly eliminate reporting requirements for physicians to participate in the Merit-based Incentive Payment System, also known as MIPS.

Morning Consult

Thursday, February 15, 2018

US spending on health care estimated to reach $5.7 trillion in 2026

Spending on health care in the U.S. will grow faster than the overall economy for the foreseeable future, according to a government report released Wednesday.

The Hill

Wednesday, February 14, 2018

Idaho Blue Cross Jumps Into Controversial Market For Plans That Bypass ACA Rules

It’s barely been two weeks since Idaho regulators said they would allow the sale of health insurance that does not meet all of the Affordable Care Act’s requirements — a controversial step some experts said would likely draw legal scrutiny and, potentially, federal fines for any insurer that jumped in.

Kaiser Health News

Wednesday, February 14, 2018

Cost Of U.S. Opioid Epidemic Since 2001 Is $1 Trillion And Climbing

The opioid epidemic has cost the U.S. more than a trillion dollars since 2001, according to a new study, and may exceed another $500 billion over the next three years.

NPR

Tuesday, February 13, 2018

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members. 

Friday
Feb092018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Trump Proposes Reduction of Drug Costs Under Medicare

President Donald Trump will propose lowering prescription drug costs for Medicare beneficiaries by allowing them to share in rebates that drug companies pay to insurers and middlemen, an administration official said.

The Associated Press

Friday, February 9, 2018

Tax Bill Sows Confusion for Nonprofit Hospitals

The $1.5 trillion tax cut bill passed late last year is bringing a windfall of money to many healthcare companies, but there's also an equal amount of confusion, reported the Wall Street Journal.

Healthcare Dive

Wednesday, February 7, 2018

Amazon: How Its Strengths Could Help It in Health Care

This month’s news that Amazon.com—along with JPMorgan Chase and Berkshire Hathaway—is getting into the health care business has sparked plenty of speculation about what the effort might do and how it might shake up the industry.

Barron's Next

Wednesday, February 7, 2018

Community Health Centers Caught In ‘Washington’s Political Dysfunction’

As lawmakers face another deadline this week for passing legislation to keep the federal government open, one of the outstanding issues is long-term funding for a key health care safety-net program.

Kaiser Health News

Monday, February 5, 2018

Disrupted: American Healthcare has Reached its Tipping Point

American healthcare has reached a tipping point. Look no further for proof than the insiders and outsiders who are linking up to disrupt the long-stagnant, cost-ridden industry that's eating up nearly a fifth of the nation's gross domestic product.

Modern Healthcare

Saturday, February 3, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Feb022018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Republicans give up on Obamacare repeal

Though the GOP still controls both chambers of Congress and maintains the ability to jam through a repeal-and-replace bill via a simple majority, there are no discussions of doing so here at House and Senate Republicans’ joint retreat at The Greenbrier resort.

Politico

Thursday, February 1, 2018

Indiana's Brand Of Medicaid Drops 25,000 People For Failure To Pay Premiums

As the Trump administration moves to give states more flexibility in running Medicaid, advocates for the poor are keeping a close eye on Indiana to see whether such conservative ideas improve or harm care.

NPR

Thursday, February 1, 2018

Expert Advice For The Corporate Titans Taking On Health Care

An announcement Tuesday by three of the nation’s corporate titans — Amazon, Berkshire Hathaway and JPMorgan Chase & Co. — that they are joining forces to address the high costs of employee health care has stirred the health policy pot. It immediately sent shock waves through the health sector of the stock market and reinvigorated talk about health care technology, value and quality.

Kaiser Health News

Wednesday, January 31, 2018

Drug distributors shipped 20M pain pills to town of 3,000 people in West Virginia

Drug distributors poured 20.8 million pain pills into a West Virginia town of 3,000 people over a 10-year period, according to information released Tuesday as part of a congressional probe into the opioid crisis. The out-of-state companies shipped the painkillers to two pharmacies four blocks apart in Williamson, W.Va., from 2006 to 2016.

The Hill

Tuesday, January 30, 2018

Health system mergers in the U.S. at record high

Hospital and health system mergers set a record in 2017, with a new report saying networks of care providers bulked up to offer a broader range of services and prepare for new contracts that ask health systems to take financial risk.

Star Tribune

Monday, January 29, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 

Friday
Jan262018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Big Pharma Greets Hundreds Of Ex-Federal Workers At The ‘Revolving Door’

Alex Azar’s job hop from drugmaker Eli Lilly to the Trump administration reflects ever-deepening ties between the pharmaceutical industry and the federal government.
Kaiser Health News
Thursday, January 25, 2018

Post-Acute Care Providers Upset Over Being Left Out of Bundled-Payment Test Program

A Trump administration initiative to change how Medicare pays health care providers excludes some of the most enthusiastic backers of a similar Obama-era program – post-acute care providers such as nursing homes and home health agencies.
Morning Consult
Tuesday, January 23, 2018

GAO: CMS Needs More Data to Manage Medicare Opioid Risks

The Government Accountability Office (GAO) has recommended that CMS should collect additional data on Medicare beneficiary opioid risks, including the number of beneficiaries with high-dose opioid prescriptions, the number of providers that overprescribe opioids, and available health plan data on overprescribing indicators.
HealthPayer Intelligence
Tuesday, January 23, 2018

Congress delays medical device tax for two years

Almost no one got everything they wanted out of the Monday deal to reopen the government — except perhaps medical device companies, who managed to fend off an industry-wide excise tax before the first payments were due.
Stat News
Monday, January 22, 2018

CHIP Renewed For Six Years As Congress Votes To Reopen Federal Government

A brief, partial shutdown of the federal government was resolved Monday, as the Senate and House approved legislation that would keep federal dollars flowing until Feb. 8, as well as fund the Children’s Health Insurance Program for the next six years.
Kaiser Health News
Monday, January 22, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday
Jan192018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, January 19, 2018

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Shutdown Looms; Blame Game Already in Full Swing

A bitterly divided Congress hurtled toward a government shutdown this weekend in a partisan stare-down over demands by Democrats for a solution on politically fraught legislation to protect about 700,000 younger immigrants from being deported.
The Associated Press
Friday, January 19, 2018

Trump again targets drug policy office, proposing 95 percent budget cut

President Donald Trump is planning to slash the budget of the Office of National Drug Control Policy, in what marks his administration’s second attempt to gut the top office responsible for coordinating the federal response to the opioid crisis.
Politico
Thursday, January 18, 2018

Four health systems band together to create generic-drug company

Four health systems have joined forces to create a not-for-profit generic-drug company with the goal of creating cheaper, more accessible pharmaceuticals for patients than are currently available on the market.
Modern Healthcare
Thursday, January 18, 2018

UnitedHealth expects $1.7B windfall from tax law

UnitedHealth Group, the country’s largest insurer, will gain $1.7 billion in additional earnings in 2018 because of the GOP tax bill, the company’s CEO said Tuesday.
The Hill
Tuesday, January 16, 2018

U.S. healthcare uninsured rises most in near decade: Gallup

The number of Americans without healthcare insurance rose by 3.2 million people between 2016 and 2017, or 1.3 percentage points to 12.2 percent, according to a Gallup poll released on Tuesday, the biggest jump in the uninsured rate in nearly a decade.
Reuters
Tuesday, January 16, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday
Jan122018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Health Insurer Centene Is Sued Over Lack of Medical Coverage

People who bought policies from Centene, a large for-profit health insurance company, filed a federal lawsuit on Thursday claiming the company does not provide adequate access to doctors in 15 states.

The New York Times

Thursday, January 11, 2018

Legislators say they are close to CHIP deal

Republicans and Democrats in Congress have said they are close to approving a long-term funding deal for the Children's Health Insurance Program, which could come as soon as next week, according to The Hill. CHIP provides insurance for nearly 9 million low-income children across the nation.

Becker's Hospital Review

Thursday, January 11, 2018

Trump administration to let states adopt Medicaid work requirements

The Trump administration told U.S. states on Thursday they can for the first time move toward imposing work or job training requirements on people as a condition for obtaining health insurance under the Medicaid government program for the poor.

Reuters

Thursday, January 11, 2018

The impact of Medicaid expansion on hospital closures

Medicaid expansion significantly decreased the number of people without insurance, and in turn may have prevented some cash-strapped hospitals from closing, according to a new study.

Fierce Healthcare

Tuesday, January 9, 2018

Drug Overdose Deaths Soar Nationally But Plateau In Some Western States

The opioid crisis on the East Coast and in the Midwest has fueled a national surge in drug deaths, even as fatal overdoses have decreased or remained stable in parts of the West, new federal data show.

Kaiser Health News

Monday, January 8, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members. 

Friday
Jan052018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, January 5, 2017

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Trump poised to take action on Medicaid work requirements

The Trump administration is preparing to release guidelines soon for requiring Medicaid recipients to work, according to sources familiar with the plans, a major shift in the 50-year-old program.
The Hill
Friday, January 5, 2018

Trump Administration Rule Paves Way For Association Health Plans

The Department of Labor on Thursday released proposed new rules that proponents say will make it easier for businesses to band together in “associations” to buy health insurance.
Kaiser Health News
Thursday, January 4, 2018

White House greenlights CMS' crackdown on Medicare Advantage plans

The White House has signed off on the CMS' proposal to ensure Medicare Advantage plans have adequate provider networks. Starting next year, the CMS will start reviewing Medicare Advantage networks on three-year cycles rather than only when a company applies to be or renews their status in the program.
Modern Healthcare
Wednesday, January 3, 2018

HHS updates rule on sharing patient substance use history

HHS issued a final rule Wednesday to ease the exchange of information on patients' substance use history between providers, insurers and third parties involved in the payment or delivery of care. The update to HHS' Substance Abuse and Mental Health Services Administration's regulatory rules aims to eliminate red tape that can slow the reimbursement process and impede timely access to care.
Becker's Hospital Review
Wednesday, January 3, 2018

Hospital groups dig in after cuts to discount drug program

Hospital groups are vowing to push forward with a fight against the Trump administration over changes to a federal drug discount program following a setback last week.
The Hill
Tuesday, January 2, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday
Dec152017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Good Deals for Some, Sticker Shock for Others As ACA Enrollment Winds Down

In most states, Friday night is the last chance to sign up for Affordable Care Act health insurance for 2018. The enrollment period is half as long as last year’s, and it got just a fraction of the marketing budget to tell consumers that.

Kaiser Health News

Friday, December 15, 2017

HHS greenlights secret pilot for Medicare Advantage to get real-time access to patient discharge records

The Department of Health and Human Services' Office of the Inspector General has given permission for a drug company to start a pilot program that will allow a private Medicare Advantage plan real-time access to a hospital's electronic patient discharge records, according to an HHS letter posted December 11.

Healthcare Finance

Wednesday, December 13, 2017

Hospitals Are Merging to Face Off With Insurers

A spate of hospital deals stands to further remake the U.S. health-care landscape, pushing up prices for consumers and insurers and changing how individuals get care. Just this month, health systems with at least 166 hospitals and $39 billion in combined annual revenue have announced merger plans.

Bloomberg

 

Physicians argue Anthem's ER policy violates federal law

Physicians are concerned about a new policy Anthem is rolling out in Indiana in January, according to WBOI. Under the new policy, which is already effective in three other states, Anthem will review diagnoses after members' emergency room visits. If the condition is determined to be nonemergent, Anthem may not cover the ER visit.

Becker's Hospital Review

Monday, December 11, 2017

8.8 million Americans face big tax hike if Republicans scrap the medical deduction

Anne Hammer is one of millions of elderly Americans who could face a substantial tax hike in 2018 depending on the final negotiations over the Republican tax bill. In her retirement community in Chestertown, Md., it’s the big topic of conversation.

The Washington Post

Sunday, December 10, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Dec082017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

House tax writers weigh plan to suspend Obamacare insurer tax

House Republican tax writers are considering delaying Obamacare's health insurance tax for only limited markets next year, leaving out small businesses and possibly private Medicaid plans, according to sources on and off Capitol Hill. They would suspend it for all markets in 2019.

Politico

Thursday, December 7, 2017

Hospitals Find Asthma Hot Spots More Profitable To Neglect Than Fix

Months of reporting and rich hospital data portray life in the worst asthma hot spot in one of the worst asthma cities: Baltimore. The medical system knows how to help. But there’s no money in it.

Kaiser Health News

Wednesday, December 6, 2017

Providers See CMS Continuing Value-Based Care Push Despite Project Rollbacks

Though the Trump administration last week rolled back several Obama-era projects designed to shift the U.S. health care system away from fee-for-service care to models that pay doctors and hospitals based on the quality of care, industry groups believe the government is likely to continue with the push toward value-based care.

Morning Consult

Tuesday, December 5, 2017

States get big Medicaid savings from social services, outreach to sickest patients

Some states have achieved dramatic savings in health care costs for their sickest Medicaid patients by providing intensive one-on-one assistance and social services that help the patients better address their multiple, overlapping ailments.

USA Today

Tuesday, December 5, 2017

CVS likely wants FTC antitrust review, not Justice Department, of Aetna deal

It is uncertain who in the U.S. government will carry out an antitrust review of CVS Health Corp’s (CVS.N) deal to buy health insurer Aetna Inc (AET.N), but the drugstore company is likely hoping the potentially more lenient Federal Trade Commission gets the nod, antitrust experts say.

Reuters

Tuesday, December 5, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Thursday
Dec072017

Are your healthcare consumers who they say they are?

By Claire Thayer, December 7, 2017

 

Verifying healthcare consumer identities has become enormously complex requiring sophisticated advanced authentication technology.  A HIMSS report on Patient Portal Identity Proofing and Authentication, tells us that the National Institute of Standards and Technology (NIST) identifies three factors as the cornerstone of identity authentication:

 

• Something you know (for example, a password)

• Something you have (for example, an ID badge or a cryptographic key)

• Something you are (for example, a fingerprint or other biometric data)

 

Multi-factor authentication refers to the use of more than one of the factors listed above, which NIST requires to reach a high level of confidence in authentication.  At least one of the factors must contain a secret that is securely presented to the electronic process that is verifying the user’s identity.  A second factor can be used to protect or activate the first. In this guidance report, the HIMSS Identity Management Task Force suggests that incorporation of smartphones as a second factor into the processes of identity proofing and authentication will significantly improve the security of electronic interactions with patients while minimizing the additional cost and difficulty.

This recent edition of the MCOL Infographic and e-Brief, co-sponsored by LexisNexis, focused on the intricacies, complexities and challenges involved with identity management:

 

 

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Friday
Dec012017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Congress Isn’t Really Done With Health Care — Just Look At What’s In The Tax Bills

Having failed to repeal and replace the Affordable Care Act, Congress is now working on a tax overhaul. But it turns out the tax bills in the House and Senate also aim to reshape health care.

Kaiser Health News

Friday, December 1, 2017

CMS makes it official: Two mandatory bundled-pay models canceled

The CMS has finalized its decision to toss two mandatory bundled-payment models and cut down the number of providers required to participate in a third.

Modern Healthcare

Thursday, November 30, 2017

CVS Nears Deal to Acquire Health Insurer Aetna

CVS Health Corp. is nearing an agreement to acquire health insurer Aetna Inc. for more than $65 billion, according to a person familiar with the negotiations, in a deal that could reshape the pharmacy and health insurance industries.

Bloomberg

Thursday, November 30, 2017

Marketplace Confusion Opens Door To Questions About Skinny Plans

Consumers coping with the high cost of health insurance are the target market for new plans claiming to be lower-cost alternatives to the Affordable Care Act that fulfill the law’s requirement for health coverage.

Kaiser Health News

Monday, November 27, 2017

As Health Care Changes, Insurers, Hospitals and Drugstores Team Up

They seem like odd couples: Aetna, one of the nation’s largest health insurers, is in talks to combine with CVS Health, which manages pharmacy benefits. The Cleveland Clinic, a highly regarded health system, joined forces with an insurance start-up, Oscar Health, to offer individuals a health plan in Ohio.

NY Times

Sunday, November 26, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Nov172017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Medicaid Expansion Takes A Bite Out Of Medical Debt

As the Trump administration and Republicans in Congress look to scale back Medicaid, many voters and state lawmakers across the country are moving to make it bigger.

Kaiser Health News

Friday, November 17, 2017

Medicare Seeks Comment On Ways To Cut Costs Of Part D Drugs

Noting that the true price of a drug is often hidden from consumers, Medicare officials requested comments late Thursday on how to use discounts and rebates to help decrease what enrollees pay for prescriptions.

Kaiser Health News

Thursday, November 16, 2017

Remembering Health Care Economist Uwe Reinhardt

Reinhardt, who died on Monday, helped shape the debate about health care by advocating for individual mandates and universal health care. Originally broadcast in 2009.

NPR

Thursday, November 16, 2017

Sign-ups hit 1.5 million in first two weeks of ACA open enrollment

HealthCare.gov sign-ups continue to outpace last year's, with nearly 1.5 million people selecting plans during the first two weeks of open enrollment.

Modern Healthcare

Wednesday, November 15, 2017

Bill Gates says big data can help solve the Alzheimer's puzzle

Through his foundation, Bill Gates has focused on reducing global poverty, finding cures for infectious diseases, and promoting education and sustainable energy. Now Gates is getting into an area that's new for him: Alzheimer's disease.

Monday, November 13, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Nov032017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

House Tax Bill Would Scrap Deduction For Medical Expenses

The tax bill unveiled by Republicans in the House on Thursday would not, as had been rumored, eliminate the tax penalty for failure to have health insurance. But it would eliminate a decades-old deduction for people with very high medical costs.

Kaiser Health News

Thursday, November 2, 2017

Hospital groups to sue CMS over $1.6 billion cut to 340B program

Less than an hour after the CMS released the final rule, America's Essential Hospitals, the American Hospital Association and the Association of American Medical Colleges said they believe the agency has overstepped its statutory authority by cutting 340B drug payments by $1.6 billion, or 22.5% less than the average sales price.

Modern Healthcare

Wednesday, November 1, 2017

Panel Recommends Opioid Solutions but Puts No Price Tag on Them

President Trump’s bipartisan commission on the opioid crisis made dozens of final recommendations on Wednesday to combat a deadly addiction epidemic, ranging from creating more drug courts to vastly expanding access to medications that treat addiction, including in jails.

The New York Times

Wednesday, November 1, 2017

U.S. states allege broad generic drug price-fixing collusion

A large group of U.S. states accused key players in the generic drug industry of a broad price-fixing conspiracy, moving on Tuesday to widen an earlier lawsuit to add many more drugmakers and medicines in an action that sent some company shares tumbling.

Reuters

Tuesday, October 31, 2017

Money For Health Law Navigators Slashed — Except Where It’s Not

Despite all the efforts in Congress to repeal the health law this summer and fall, the Affordable Care Act is still the law of the land. People can start signing up for health insurance for 2018 starting Nov. 1. But the landscape for that law has changed a lot.

Kaiser Health News

Monday, October 30, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Oct272017

Fighting Healthcare fraud and over-prescriptions with predictive analytics

By Claire Thayer, October 31, 2017

Earlier this summer, the U.S. Department of Justice announced the largest ever health care fraud enforcement action, involving over 412 individuals across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Adoption of prescription drug monitoring programs is one way to hold health care providers accountable for overprescribing practices. Use of sophisticated claims analytic tools can help detect suspicious practice patterns as well. A health plan in the Midwest recently uncovered the case of an overprescribing neurologist using peer-to-peer analysis for comparison of practice patterns.

This recent edition of the MCOL Infographic, co-sponsored by LexisNexis, provides highlights from this case study:

 

Friday
Oct272017

Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

CVS Health's surprising deal for Aetna? It's all about Amazon
Amazon.com Inc has gained approval from a number of state pharmaceutical boards to become a wholesale distributor, St. Louis Post-Dispatch reported on Thursday, citing public records.
CNBC News
Thursday, October 27, 2017

Trump Declares Opioid Crisis a ‘Health Emergency’ but Requests No Funds
President Trump on Thursday directed the Department of Health and Human Services to declare the opioid crisis a public health emergency, taking long-anticipated action to address a rapidly escalating epidemic of drug use.
The New York Times
Thursday, October 26, 2017

Amazon gains wholesale pharmacy licenses in many U.S. states: report
Amazon.com Inc has gained approval from a number of state pharmaceutical boards to become a wholesale distributor, St. Louis Post-Dispatch reported on Thursday, citing public records.
Reuters
Thursday, October 26, 2017

Trump health official Seema Verma has a plan to slash Medicaid rolls
With a broad overhaul of Obamacare stalled in Washington, one of President Trump’s top health care leaders is drawing the outlines of sweeping changes to Medicaid that could pare enrollments and cut costs without congressional approval.
Stat News
Thursday, October 26, 2017

ACA stabilization bill would lower deficit by $3.8B, CBO says
The Senate HELP Committee’s bipartisan Affordable Care Act stabilization bill would lower the federal deficit by $3.8 billion from 2018-2027, according to the Congressional Budget Office.
Fierce Healthcare
Wednesday, October 25, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

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