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Docs see smaller checks as Congress weighs options on Medicare cut

Docs see smaller checks as Congress weighs options on Medicare cut

January 30, 2024

MICHAEL MCAULIFF   

If anyone were to ask members of Congress if doctors should be contending with Medicare pay cuts after a pandemic and a period of extraordinary inflation, and amid a chronic physician shortage, nearly all would say no.

Yet, that is what happened on Jan. 1, and even powerful lawmakers who would like to ease or reverse that cut can’t promise it will happen, even after recent actions to forestall hospital cuts and to extend expiring healthcare programs such as federally qualified health centers.

Physicians hit with Medicare pay cut under final rule

Physicians hit with Medicare pay cut under final rule

November 02, 2023

ALISON BENNETT  

Physicians will be hit with a 1. 25% reduction in Medicare reimbursements next year under a final rule the Centers for Medicare and Medicaid Services issued Thursday.

The American Medical Association and other doctor groups sharply criticized the proposed rule CMS published in July, which contained the same pay cut, and have taken their case to Congress that Medicare fees for physicians should not be reduced.

CMS unveils integrated mental health pilot program

CMS unveils integrated mental health pilot program

January 18, 2024

ALISON BENNETT  

The Centers for Medicare and Medicaid Services is testing a new community-based behavioral health services model that aims to improve access and quality, the Health and Human Services Department announced Thursday.

Under the Innovation in Behavioral Health Model, physical and mental healthcare providers will form interprofessional care teams with community organizations, which will coordinate care for Medicare and Medicaid enrollees with mental illnesses and substance-use disorders.

How private equity could be affecting patient safety in hospitals

How private equity could be affecting patient safety in hospitals

January 04, 2024

MARI DEVEREAUX   

Hospitals purchased by private equity firms have higher rates of adverse patient safety events than other facilities, according to a recent study, and its authors said the findings could be indicative of how the acquisitions affect hospital operations.

The study published in JAMA found hospital-acquired conditions like surgical infections and pressure ulcers increased by 25% among Medicare patients at private equity-owned facilities compared with a control group of hospitals.

Physicians leaving private practice hurt patient care: survey

Physicians leaving private practice hurt patient care: survey Doctor and Patient

December 05, 2023

MARI DEVEREAUX   

Physicians leaving private practice for employment has hurt patient care quality, according to a recent survey of doctors commissioned by the Physicians Advocacy Institute. 

The survey polled 1,000 physicians employed by insurers, health systems, staffing agencies and private equity firms on how corporate ownership affects their workplace experience and ability to meet patients’ needs. The research was conducted by NORC at the University of Chicago.

Fewer physicians are owning practices. Here’s why.

Fewer physicians are owning practices. Here’s why.

July 13, 2023

CAROLINE HUDSON   

Medical practices are getting larger, and physicians are less likely to own them, according to a report from the American Medical Association.

Carol Kane, AMA’s director of economic and health policy research, compiled the report released Wednesday by analyzing data from the association’s biennial Physician Practice Benchmark Surveys from 2012 to 2022. The most recent survey was conducted in late 2022 and included data from 3,500 post-residency physicians.

Are insurers using tech to automate claims denials?

Are insurers using tech to automate claims denials?

November 21, 2023

LAUREN BERRYMAN   
BROCK E.W. TURNER 

The alleged use of artificial intelligence for prior authorization and claim denials has led to lawsuits against two major health insurance companies.

UnitedHealth Group and Cigna have been separately accused of allegedly using automated tools to deny some claims, which plaintiffs say reduces the insurers’ labor costs. Both policymakers and physician leaders are asking insurance companies to open up their AI playbooks in response to these allegations.

Physicians hit with Medicare pay cut under final rule

Physicians hit with Medicare pay cut under final rule

November 02, 2023

ALISON BENNETT 

Physicians will be hit with a 1.25% reduction in Medicare reimbursements next year under a final rule the Centers for Medicare and Medicaid Services issued Thursday.

The American Medical Association and other doctor groups sharply criticized the proposed rule CMS published in July, which contained the same pay cut, and have taken their case to Congress that Medicare fees for physicians should not be reduced.

Hospitals due $9B under 340B final rule

Hospitals due $9B under 340B final rule Hospitals due $9B under 340B final rule

11/02/23

ALEX KACIK  
ALISON BENNETT  

Providers participating in the 340B drug discount program will receive approximately $9 billion to compensate them for reductions in previous years under a final rule the Health and Human Services Department and the Centers for Medicare and Medicaid Services published Thursday.

CMS will distribute the money in lump sums to eligible providers to undo reimbursement cuts from 2018 to 2022, which the Supreme Court ruled invalid last year. About 1,700 hospitals are due to receive funds by Jan. 1. But because federal law requires this spending to be budget-neutral, CMS offset the cost by reducing reimbursements for other outpatient products and services by $7.8 billion.