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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5 things to know about final Medicare Advantage, Part D rule for 2019

CMS has finalized its rule for 2019 rates for Medicare Advantage and Medicare Part D, giving insurers a bigger-than-expected rate increase while finalizing proposals on expanded supplemental benefits and efforts aimed at fighting opioid addiction.

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Doctors suing Atrium Health will be allowed to leave system

In a lawsuit aimed at allowing a physician practice to break away from the region’s dominant health system, physicians at the Mecklenburg Medical Group (MMG) have accused Charlotte’s Atrium Health of monopolistic practices that have been harmful to patients and go against its nonprofit mission. Atrium responded by saying the 92 doctors who want to leave will be allowed to do so.

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New CDC director: We can end AIDS epidemic within 7 years

In his first all-staff meeting as director of Centers for Disease Control and Prevention, Robert Redfield, MD, predicted the U.S. could end the AIDS epidemic with tools already available. He also committed the agency’s policies to be rooted in scientific evidence.

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Sutter Health sued by California for alleged anticompetitive practices

California Attorney General Xavier Becerra announced his office has filed an antitrust lawsuit against Sacramento-based Sutter Health, alleging the system used its dominance in Northern California to unlawfully raise prices for services and then used the profits reaped from these practices to grow even larger.

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5 legislative, regulatory priorities for hospitals in 2018 and beyond

The failure to pass funding for reinsurance and cost-sharing reduction subsidies for the Affordable Care Act (ACA) exchanges and the potential for pharmaceutical-backed changes to the 340B drug discount program are just some of the major issues on the American Hospital Association’s radar this year, according to executive vice president of government affairs Tom Nickels.

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WSJ: Walmart in talks to buy Humana

In the latest example of an outside force making a move into healthcare, retail giant Walmart—the largest company in the world by revenue—is reportedly in preliminary discussions to acquire health insurer Humana, according to the Wall Street Journal.

AAMC: Med schools, teaching hospitals generate $562B, 3.1% of GDP

Not far from any policy debate is the oft-repeated fact that healthcare makes up one-sixth of the U.S. economy. Newly published research took a deeper dive to investigate the impact of medical schools and teaching hospitals. And, as one would guess, they contribute a lot of the American economy, accounting for 3.1 percent of gross domestic product.

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Upside-only ACOs increased Medicare spending

Accountable care organizations (ACOs) were supposed to result in savings for Medicare, but an analysis from Avalere said ACOs in the Medicare Shared Savings Program (MSSP) have instead increased federal spending—an evaluation a national group of ACOs called “rather simplistic," ignoring positive impacts they've made on quality.

Around the web

Compensation for heart specialists continues to climb. What does this say about cardiology as a whole? Could private equity's rising influence bring about change? We spoke to MedAxiom CEO Jerry Blackwell, MD, MBA, a veteran cardiologist himself, to learn more.

The American College of Cardiology has shared its perspective on new CMS payment policies, highlighting revenue concerns while providing key details for cardiologists and other cardiology professionals. 

As debate simmers over how best to regulate AI, experts continue to offer guidance on where to start, how to proceed and what to emphasize. A new resource models its recommendations on what its authors call the “SETO Loop.”