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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CMS asks for comment on direct provider contracting model for Medicare

In an April 23 release, CMS announce it is seeking input on an alternative payment model that would allow direct provider contracting (DPC) between payers and primary care or multi-specialty groups. CMS asked for comments to inform possible testing for such a model for Medicare Parts A and B, Medicare Advantage and Medicaid.

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White House indefinitely postpones Trump's speech on lowering drug prices

President Donald Trump has postponed this week’s speech on battling rising prescription drug costs, according to the White House. No future date, time or location has been announced for the speech, previously scheduled for Thursday, April 26.

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Primary care may be skipped under high-deductible ACA plans

Higher deductible bronze-level plans were more popular on the Affordable Care Act (ACA) exchanges in 2018, but customers may not be aware that moving toward this coverage will leave them paying out of pocket for primary care until they hit their deductible—leading some to avoid primary care altogether due to the costs.

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Democrat senator’s report calls tax law ‘bonanza’ for healthcare

Some of the largest healthcare companies, including for-profit hospital chains, insurers and pharmaceuticals, will pay a combined $10 billion less in taxes for 2018 thanks to the corporate tax cuts passed by Republicans and signed into law by President Donald Trump, according to a report published by Sen. Ron Wyden, D-Oregon.

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Healthcare groups want MIPS changes on measures, reporting period

The Medical Group Management Association (MGMA), American Medical Association (AMA) and the American College of Physicians (ACP) are asking for changes to the Merit-based Incentive Payment System (MIPS), with a wide group of stakeholders wanting the quality reporting period reduced to 90 days and ACP releasing a study determining many MIPS measures aren’t valid.

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DOJ will examine Cigna-Express Scripts deal

The U.S. Department of Justice (DOJ) will review Cigna’s $67 billion proposal to acquire Express Scripts, the results of which are likely to have major ramifications on other vertical integrations being explored across healthcare.

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Procter & Gamble buying Merck’s health brands for $4.2B

Procter & Gamble has announced it will acquire the consumer health business of Germany-based Merck in a $4.2 billion deal, adding more over-the-counter medications to P&G’s existing product offerings.

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Dem senators introduce plan for ‘public option on steroids’

Millions more Americans could pick Medicare as their health insurer under a bill introduced by Sens. Chris Murphy, D-Connecticut, and Jeff Merkley, D-Oregon, by making it a public insurance option on the Affordable Care Act (ACA) exchanges and for employers.

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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