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.
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.
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.
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.
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.
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.
September 21, 2023
ALEX KACIK
The Federal Trade Commission sued U.S. Anesthesia Partners, one of the nation’s largest anesthesia providers, and its private equity owner Welsh, Carson, Anderson & Stowe for allegedly consolidating its practices in Texas to drive up prices for patients.
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.
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.
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.
