June 13, 2024
NONA TEPPER
The Centers for Medicare and Medicaid Services has recalculated some Medicare Advantage star ratings for the 2024 plan year after two federal courts found it improperly modified how it assesses quality, the agency notified health insurance companies Thursday.
In addition to the possibility of revised scores and additional revenue for 2024, Medicare Advantage carriers whose star ratings are increased will be permitted to resubmit their bids for next year.
September 05, 2023
CAROLINE HUDSON
Physician compensation is on the rise as provider organizations try to attract more doctors in a tight labor environment.
The industry is still responding to post-COVID-19 pandemic market dynamics, according to companies that responded to Modern Healthcare’s 2023 Physician Compensation Survey, which analyzes data from nine staffing and consulting firms. As patients return for deferred procedures, burned-out doctors are taking a step back from work and students are rethinking career options, creating supply-demand mismatches.
May 16, 2024
MICHAEL MCAULIFF
A House subcommittee took the next steps Thursday to extend telehealth flexibilities and expanded remote patient monitoring rules due to expire at the end of the year.
The House Energy and Commerce Subcommittee on Health voted overwhelmingly to send to the full committee the Telehealth Enhancement for Mental Health Act of 2024, the Telehealth Modernization Act of 2024 and the Expanding Remote Monitoring Access Act of 2024.
April 29, 2024
NONA TEPPER
A rural health system sued technology company MultiPlan and eight of the country’s largest insurance companies over alleged schemes to strongarm providers into accepting low out-of-network rates.
At issue in the proposed class-action suit are MultiPlan’s repricing tools, which allegedly rely on insurers’ data to deflate their out-of-network reimbursement payments.
MultiPlan acts as an intermediary between insurers and providers to help negotiate pay when a contract does not exist and protect patients from being “balance billed,” or charged the difference between the hospital rate and insurer’s allowed amount.
April 24, 2024
Leah Nylen, Bloomberg
Business groups led by the US Chamber of Commerce sued the Federal Trade Commission Wednesday seeking to block a rule finalized this week that would outlaw non-compete provisions that prohibit workers from switching jobs within an industry.
In a complaint filed in Texas federal court, the nation’s largest business lobby argued that the antitrust and consumer protection agency lacks the authority to issue rules that define unfair methods of competition. The FTC Act, which established the agency, allows it to bring cases challenging particular practices, the group said, but not to write rules. The Chamber was joined by Business Roundtable and several Texas business groups in challenging the rule.
April 17, 2024
Lauren Coleman-Lochner, Bloomberg
Private equity-owned businesses accounted for a high number of bankruptcies in the healthcare sector last year, and another wave of distress looms, according to a new report from an advocacy group that monitors the sector.
PE-backed firms accounted for at least 17, or about a fifth, of the 80 bankruptcies of healthcare companies last year, the Private Equity Stakeholder Project said in a report due to be released Wednesday. It called 2023 a “record year” for large health-care bankruptcies. Also, venture-capital backed companies made up another 12, or 15%, of the filings, it said in a study that looked at companies with liabilities of more than $10 million.
April 01, 2024
LAUREN BERRYMAN
NONA TEPPER
Medicare Advantage insurers will get lower payments next year, the Centers for Medicare and Medicaid Services confirmed in a final rule published Monday.
The Medicare Advantage benchmark rate will decline 0.16% in 2025 under the regulation, which is the same amount the agency proposed in January. This marks the second consecutive year CMS reduced the benchmark rate.
April 04, 2024
KARA HARTNETT
Healthcare consolidation is expected to remain strong in the coming months, given likely cuts in interest rates, health systems’ ongoing pursuit of financial stability and expansion opportunities, and the growing influence of private equity in care delivery.
Private equity firms are increasingly acquiring physician practices and healthcare staffing firms, while hospitals are exploring mergers to reduce costs through economies of scale. Additionally, the industry is seeing growing interest in forming joint ventures and affiliations to bolster financial resilience and diversify services.
March 25, 2024
TIM BRODERICK
LAUREN BERRYMAN
The healthcare industry is starting to play catch-up following a cyberattack on UnitedHealth Group’s Change Healthcare subsidiary nearly five weeks ago that forced the company to disconnect its vital everyday systems.
Change Healthcare processes about 50% of medical claims and manages prior authorization requests and reimbursement processes. The unprecedented network outage has forced hospitals, nursing homes, pharmacies and other providers to scramble as they try to mitigate operational and financial challenges.
March 13, 2024
LAUREN BERRYMAN
The federal government has launched an investigation into UnitedHealth Group and its Change Healthcare subsidiary regarding the unprecedented cyberattack inflicted on the technology company that has wreaked havoc throughout the healthcare system.
Melanie Fontes Rainer, director of the Health and Human Services Department’s Office for Civil Rights, announced the probe Wednesday in a letter addressed to colleagues.
The agency is looking into whether protected health data was compromised and if UnitedHealth has complied with breach notification requirements and federal privacy and security rules.