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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Provider-sponsored Medicare Advantage plans seeing big growth in membership

The growth in Medicare Advantage membership has benefited hospitals and physician groups that operate their own plans, with total enrollment increasing by more than 20 percent to three million beneficiaries since 2015.

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Buyer be aware: CMS looks to require hospitals post prices online

A new CMS proposal will require hospitals to post their standard prices for treatments online and aims to increase patient access to electronic health records (EHRs).

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6 ways to rein in costs in the US healthcare system

An academic and insurance executive discussed innovations to control healthcare costs in the U.S., including pricing reforms and payment modifications.

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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.

Around the web

If passed, this bill would help clinician-led clinical registries explore Medicare data for research purposes. The Society of Thoracic Surgeons and American College of Cardiology both shared public support for the bipartisan legislation. 

Cardiologists and other physicians may soon need to provide much more information when ordering remote patient monitoring for Medicare patients.

Why are so many cardiovascular devices involved in Class I recalls? One possible reason could be the large number of devices hitting the market without undergoing much premarket clinical testing. 

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