Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies. 

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New Cigna plan caps monthly out-of-pocket insulin costs at $25

Cigna and Express Scripts announced April 3 they’re launching a Patient Assurance Program that will ensure individuals with diabetes pay no more than $25 out-of-pocket for insulin each month.

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There’s a better way to score hospitals with 1 to 5 stars, researchers say

The creators of CMS’s Overall Hospital Quality Star Rating ratings system—aka “Hospital Compare”—intended to present healthcare consumers with an easy, user-friendly way to choose a hospital. However, since the ratings went live in 2016, the system has proven both confusing to consumers and confounding to hospitals.

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Federal judge rejects expansion of association health plans

A federal judge rejected the Trump administration’s efforts to expand access to association health plans March 29, throwing small businesses that rely on those plans into a state of uncertainty, the Washington Post reported.

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Female Ob/Gyns paid $67K less than male colleagues

Women physicians who work in reproductive health for women earn an average $67,000 less per year than men working in the same field. The pay gap cuts across subspecialties within it, such as reproductive endocrinology, and it holds even after adjusting for years of experience, hours worked and other variables.

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1 in 7 patients receive surprise medical bills

Roughly 1 in 7 patients—or 14.5 percent of hospital admissions in the U.S.—experience surprise medical billing despite seeking care at an in-network facility, according to an analysis by the Health Care Cost Institute (HCCI).

Medicare FFS amassed $23.2B in improper payments in 2017

Medicare fee-for-service (FFS) programs racked up an estimated $23.2 billion in improper payments in 2017, according to CMS data—almost $19 billion more than Medicaid FFS’ $4.3 billion and a red flag that the program’s documentation requirements might not be up to par.

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Purdue Pharma reaches $270M settlement in opioid case

Purdue Pharma agreed to a $270 million settlement March 26 to help battle Oklahoma’s opioid crisis after a slew of lawsuits threatened to edge the company into bankruptcy.

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‘All-out war’: Trump administration supports ruling to invalidate entirety of Obamacare

The Trump administration filed a notice March 25 supporting a federal judge’s ruling that the Affordable Care Act should be thrown out in its entirety—a sharp pivot from the administration’s previous position that only parts of the law should be eradicated.

Around the web

With generative AI coming into its own, AI regulators must avoid relying too much on principles of risk management—and not enough on those of uncertainty management.

Cardiovascular devices are more likely to be in a Class I recall than any other device type. The FDA's approval process appears to be at least partially responsible, though the agency is working to make some serious changes. We spoke to a researcher who has been tracking these data for years to learn more. 

Updated compensation data includes good news for multiple subspecialties. The new report also examines private equity's impact on employment models and how much male cardiologists earn compared to females.

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