Where healthcare challenges find solutions
Bundled payments reduce surgery costs by 10.7%
Joint replacement, spinal fusion and gastrointestinal surgeries were on average $4,229 less when providers charged a set price.
Coordinated payment policies could speed transition to value, experts say
Experts recommended that CMS promote equity with advanced payment models that prioritize reducing disparities and tie financial performance to health equity outcomes.
CMMI's geographic direct contracting model needs an overhaul, experts say
Insiders worry that the Geographic Direct Contracting model is too complicated to put into practice, which could frustrate Medicare beneficiaries and make it more difficult to coordinate and manage care.
Hospitals fight UnitedHealthcare policies over lab test, specialty drug payments
The American Hospital Association is asking the federal government to restrict UnitedHealthcare policies that threaten reimbursement for diagnostic lab tests and specialty drugs.
Cigna eliminates prior authorization for coronary CT scans
Cigna will no longer require prior authorization for some CT scans of the heart, a move that providers said will relieve administrative burdens among physicians and result in better outcomes for patients.
Hospitals get 'raw deal' as CMS rejects site-neutral pay cut exemptions
CMS rejected more than 60% of the exceptions that would preserve hospitals' higher reimbursement rates if they could prove their off-campus outpatient departments were in construction in 2015.
Regional insurers bet big on virtual-first plans
Over the past few years, an increasing number of regional insurers have launched virtual-first plans for the first time, in a move to differentiate themselves from larger insurers in their markets.
MedPAC votes to boost hospital payments, freeze or cut other providers
The Medicare Payment Advisory Commission doesn't expect the recommendations to decrease Medicare beneficiaries' access to care or lower quality.
Most Next Gen ACOs achieved bonuses in 2019
Overall, the 37 ACOs earned about $461.9 million in shared savings. The model is now in its final performance year.
Congress recalibrates Medicare Physician Fee Schedule after lobbying
Specialty physician groups successfully fought to mitigate pay cuts after the Medicare Physician Fee Schedule was released.
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