Category: News

Healthcare professionals fleeing industry, new data show

Healthcare professionals fleeing industry, new data show

October 16, 2023

ALEX KACIK 

More than 145,000 healthcare practitioners left the industry from 2021 through 2022, threatening access and quality, according to a report published Monday.

Physicians accounted for roughly half of the healthcare workers who retired or changed professions over the two-year span, according to an analysis of all-payer claims data from Definitive Healthcare, a healthcare commercial intelligence company. More than 71,000 physicians left the workforce from 2021 to 2022.

Envision Healthcare bankruptcy restructuring approved by court

Envision Healthcare bankruptcy restructuring approved by court

October 11, 2023

CAROLINE HUDSON 

Envision Healthcare plans to emerge from Chapter 11 bankruptcy this month, the physician staffing company announced Wednesday.

The U.S. Bankruptcy Court for the Southern District of Texas approved a reorganization plan for Envision Healthcare that will eliminate 70% of its funded debt. The for-profit company expects to finalize the transaction within weeks, according to a news release.

More hospitals to be charged readmissions penalties: CMS

More hospitals to be charged readmissions penalties: CMS

September 15, 2023

MARI DEVEREAUX 

More hospitals will face readmissions penalties in 2024, a departure from the lower rates of reimbursement cuts providers saw last year, according to preliminary data released Thursday.

While the Centers for Medicare and Medicaid Services has resumed use of its pneumonia readmissions measure, which was excluded last year from its Hospital Readmissions Reduction Program, payment adjustments have not returned to pre-pandemic levels.

Why insurers are scaling back prior authorizations

Why insurers are scaling back prior authorizations

September 07, 2023

NONA TEPPER

Some health insurance companies are rethinking prior authorization amid a groundswell of complaints from patients and providers and intensifying government scrutiny.

Health insurance companies employ prior authorization rules to constrain costs and to limit unnecessary care, much as insurers place limits on coverage in other ways. Yet big players such as UnitedHealth Group, Cigna and several Blue Cross and Blue Shield companies have announced plans this year to relax their precertification policies. Provider groups have applauded these announcements, albeit cautiously.

CMS updates HCAHPS survey amid declining scores

CMS updates HCAHPS survey amid declining scores

August 09, 2023

MARI DEVEREAUX

The Centers for Medicare and Medicaid Services is revising its patient experience survey to address low response rates and expand data on care quality.

Announced Aug.1 as part of the agency’s inpatient prospective payment system final rule, the modifications to the Hospital Consumer Assessment of Healthcare Providers and Systems survey have been years in the making.

Before the COVID-19 pandemic, stakeholders advocated for CMS to improve the HCAHPS survey by changing its response format and fine-tuning the measures included. Now, with more patients reporting declines in their hospital experiences, CMS is sharpening its focus on improving the survey process. 

Cigna lawsuit over algorithm allegations could be first of many

Cigna lawsuit over algorithm allegations could be first of many

July 25, 2023

NONA TEPPER

Two Cigna members filed a lawsuit seeking class-action status in a California federal court on Monday, alleging the health insurance company leveraged an algorithm to improperly deny claims and systematically shift costs to its 2.1 million Golden State members. Lawyers anticipate more insurers will be hit with similar complaints as carriers increasingly automate their claims management processes.

Enrollees Suzanne Kisting-Leung and Ayesha Smiley sued Cigna in the U.S. District Court for the Eastern District of California, alleging the company used an algorithm called PXDX to review patient claims, which violated its fiduciary duty dictated by state law.

Healthcare industry reacts to affirmative action ruling

Healthcare industry reacts to affirmative action ruling

June 29, 2023

KARA HARTNETT 

The Supreme Court ruling that higher education institutions may not consider race when making admission decisions could have far-reaching consequences for the healthcare industry.

The ruling issued Thursday applies to public and private schools that receive federal funding and culminates legal challenges to the admissions polices at the University of North Carolina and Harvard University. In 2014, applicants sued the colleges, arguing that applying affirmative action to admissions unfairly diminished their chances of being accepted. The Supreme Court’s conservative majority ruled 6-3 in their favor.

Healthcare costs to grow 7% next year: PwC

Healthcare costs to grow 7% next year: PwC

June 29, 2023

ALEX KACIK  

Healthcare costs are expected to rise 7% next year as providers deal with higher expenses and seek rate increases during contract negotiations with insurers.

The projection by PricewaterhouseCoopers’ Health Research Institute tops the consultancy’s estimates in 2022 and 2023, which were 5.5% and 6%, respectively.

For their annual report, PwC researchers spoke with actuaries who work with insurers covering 100 million employer-sponsored members and 10 million Affordable Care Act members to forecast healthcare inflation. The results were weighted by each health plan’s size.

DOJ announces charges in massive healthcare fraud crackdown

DOJ announces charges in massive healthcare fraud crackdown

June 28, 2023

Associated Press

WASHINGTON — The Justice Department has charged dozens of people in several healthcare fraud and prescription drug schemes, including one totaling $1.9 billion and a doctor accused of ordering fake ankle braces for a patient whose leg had been amputated, officials said Wednesday.

The scheme involving the submission of nearly $2 billion in bogus claims is one of the largest healthcare fraud cases ever brought by the Justice Department, the agency said. It’s one of several announced as part of a crackdown in states around the country.