With healthcare reimbursement quickly evolving to primarily a value-based model, many physicians fear the inevitable repercussions of not being prepared for contracting based upon patient outcomes. The unveiling of CMS’ Value-Based Modifier, the general market movement since the Affordable Care Act, the…
Since 1965, a lot has changed in the world of Healthcare policy. Medicare has opened doors to health care and increased economic security for hundreds of millions of older people, people with disabilities, and their families. Since 1986, the Center…
The Government Accountability Office recommends that Congress removes the financial incentives the government pays hospitals as part of the 340B drug program. The GAO is concerned that this financial encouragement results in over-prescribing of medications at Disproportionate Share Hospitals (DSHs),…
Since their inception, narrow networks have been expanding due to consumers being increasingly willing to have reduced provider choices in exchange for lower premiums. Insurance companies are able to keep the premium lower by taking out high-cost employers. In addition,…
By: Sara Rosenbaum Despite its monumental achievement, the Affordable Care Act (ACA), like any landmark piece of legislation, was only the beginning. Its aim was grand, but even putting aside the wild circumstances of its enactment, it was evident that effective…
During the last 140 years St. Joseph’s Hospital has grown from a ramshackle, 12-room building to the technologically advanced 330-bed medical center of today. “On this day we recognize not only one of the oldest hospitals in the nation, but…
Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States As of Spring 2015, states had completed the second open enrollment period for the new Health Insurance Marketplaces established by the Affordable Care Act (ACA) and most of…
Humana has posted a policy/coding update that will take effect on 9/14/2015: http://apps.humana.com/marketing/documents.asp?file=2642614 Unless otherwise noted below, these updates will be applicable across all of Humana’s product lines (commercial & Medicare): Humana addresses maximum dosages/acceptable diagnosis codes for several drugs…
Survey: Healthcare Finance, Reform Top Issues Confronting Hospitals in 2014 CHICAGO, January 12, 2015—Financial challenges again ranked No. 1 on the list of hospital CEOs’ top concerns in 2014, according to the American College of Healthcare Executives’ annual survey of…
The 340B drug discount program is currently under consideration for changes that will affect hospitals and physicians alike. Hospitals typically would like to keep the program how it is, while physicians are striving for reform. The drug discount program has been giving…