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Exploring the Relationship Between Price and Competition Among Physician Practices

The latest from the Journal of the American Medical Association (JAMA) is a thematic issue organized around a prominent topic in healthcare: price, cost, and competition. Contributing to the debate is an article titled,...more

10/30/2014 - Competition Healthcare Healthcare Costs JAMA Physicians

From Competitors to Co-Adventurers, Seven Hospital Systems Join with Anthem Blue Cross to Shake Things Up in Southern California

Anthem Blue Cross and seven competing hospital systems in Southern California are joining forces to establish a new health plan offering, Vivity.[1] Operating with a combined 14 hospitals and approximately 6,000 physicians,...more

10/14/2014 - Blue Cross CalPERS Health Insurance Healthcare Hospitals

The True Meaning of “Save Money. Live Better” – Walmart Enters the Primary Care Market

As reported in the New York Times, Walmart has taken the plunge into the retail primary care healthcare delivery market. Walmart has opened six primary care locations in South Carolina and Texas and plans to open another six...more

9/9/2014 - Healthcare Wal-Mart

Pennsylvania gets a green light to pursue Medicaid expansion under an alternative model

The Centers for Medicare and Medicaid Services (CMS) has approved Pennsylvania’s demonstration proposal to expand Medicaid to adults with incomes through 133 percent of the federal poverty line. The state is the 28th...more

9/8/2014 - CMS Healthcare Medicaid Expansion

Shifting to Value-Based Reimbursement

The Blue Cross Blue Shield Association released an interesting survey over the summer (July 2014) that provides further evidence of the change that is now happening in the American healthcare delivery system....more

9/5/2014 - Blue Cross Blue Shield Healthcare Surveys Value-Based Purchasing

Nonprofit Hospital Revenue Growth Slows

For the second straight year in a row, nonprofit hospital expenses have increased more than revenue, according to a study of 383 hospital systems by Moody’s Investors Service released on August 27, 2014. In an article...more

9/4/2014 - Hospitals Non-Profits

Another Pioneer Leaves The West

Another withdrawal from the Medicare Pioneer Accountable Care Organization (ACO) program has occurred. Sharp Healthcare ACO, an affiliate of the Sharp integrated delivery system in San Diego, California, notified the Center...more

9/3/2014 - ACOs CMS Healthcare Medicare Shared Savings Program

Bundled Payments under the Affordable Care Act Continue to Gain Influence

The Center for Medicare and Medicaid Services (CMS) recently announced that it will add roughly 4,100 providers to the 2,400 existing providers testing the possible use of Medicare bundled payment contracts. Providers must...more

8/12/2014 - Affordable Care Act Bundling Rules CMS Employee Benefits Healthcare

Highlights from the Senate Special Committee on Aging’s Hearing on Medicare Observation Status

A recent Senate Special Committee on Aging hearing focused on the impact of Medicare observation status, a hospital outpatient designation for which Medicare covers fewer services and generally reimburses for services at a...more

8/7/2014 - Congressional Investigations & Hearings Hospitals Legislative Committees Medicare Two-Midnight Rule

Tying health spending to the economy: What does it mean for the future?

Politicians, researchers, and other stakeholders have long recognized the importance of a slowdown in health spending in the U.S. Optimistically, the nation’s health spending has experienced a record slow growth rate in...more

7/30/2014 - CBO Report Healthcare Costs JAMA Medicare

OIG issues Special Fraud Alert on laboratory payments to referring physicians

The Health and Human Services Office of the Inspector General (OIG) recently issued a Special Fraud Alert on laboratory payments to referring physicians. Specifically, the alert is concerned with Specimen Processing...more

7/9/2014 - Anti-Kickback Statute Clinical Laboratories Fraud OIG Physicians Risk Alert

CMS seeks to update payment rates and eligibility certification requirements in proposed rule for Medicare home health services

On July 7, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule updating Medicare’s Home Health Prospective Payment System payment rates for 2015....more

7/8/2014 - CMS Healthcare Home Health Care Medicare

A “virtual merger” is underway between Chicago-area Alexian Brothers Health System and Adventist Midwest Health

Chicago-area Alexian Brothers Health System and Adventist Midwest Health signed a non-binding letter of intent to form a joint operating company, a collaboration commonly referred to as a virtual merger. As Alexian brings...more

6/26/2014 - ACOs Adventist Midwest Health Alexian Brothers Health System Healthcare Hospitals Letters of Intent Virtual Merger

Quantifying and addressing improper payments for Medicare evaluation and management services

A review of Medicare Part B claims for evaluation and management (E/M) services conducted by the Office of the Inspector General (OIG) has found that the program paid $6.7 billion in improper payments in 2010. This figure...more

6/3/2014 - CMS Evaluation and Management Services Healthcare Healthcare Professionals Medicare Medicare Part B OIG Overpayment Physicians

Proposed modifications to EHR Incentive Programs

Last year, HHS revised policies and definitions surrounding what constitutes certified EHR technology—required for meaningful use incentive program payment eligibility—from the 2011 Edition criteria to the 2014 Edition...more

5/28/2014 - CMS Data Protection EHR Healthcare HHS HIPAA PHI

In Michigan, CHE Trinity Health and Ascension Health Network come together in Together Health Network

Competitors CHE Trinity Health Michigan and Ascension Health Michigan recently announced the Together Health Network, LLC—a separate and jointly owned, statewide, clinically integrated health network....more

5/20/2014 - Healthcare Hospitals Networks

Innovation Health: A joint venture approach to payer-provider integration in Virginia

In 2012, Aetna and Inova, a not-for-profit health system in Virginia, formed a joint venture health plan: Innovation Health. The health plan is an entirely new entity owned jointly by both organizations. Its network...more

4/30/2014 - Healthcare Joint Venture

Has New York State Failed its Hospitals?

According to New York’s Department of Health Commissioner, “nearly half [of] New York’s 227 hospitals are financially distressed.” What then is the future for New York’s hospitals, especially in light of healthcare...more

4/28/2014 - Equity Financing Healthcare Healthcare Reform Hospitals

Oscar, a new, venture-backed health insurance company, seeks to compete against industry giants

The Affordable Care Act is driving innovation at all levels of the healthcare system, creating opportunities for small start-ups to compete with industry giants. One such start-up is Oscar, a venture-backed health insurance...more

4/24/2014 - Affordable Care Act Healthcare Innovation Startups

New Data Shows Higher Healthcare Costs in Second Half of 2013 – Is this A Result of the Affordable Care Act?

Will insurance expansion and industry consolidation result in higher healthcare costs, at least in the short term, and further stress the economy and the healthcare industry? That highly political question is being asked now...more

4/22/2014 - Affordable Care Act Health Insurance Healthcare

HHS releases new software for updating (but not replacing) HIPAA security risk assessment toolkits

Last week, the Department of Health and Human Services (HHS) released a new, free, downloadable tool to assist small and medium-size health care provider offices to conduct security risk assessments (SRA)....more

4/15/2014 - Healthcare Professionals HHS HIPAA Physicians Security Risk Assessments Software

New Approaches – and Increasing Oversight – for Medicaid Managed Long Term Services and Support

Approximately one-third of Medicaid spending, $136 billion, is on long-term services and supports (LTSS). While the majority of Medicaid LTSS takes place in institutional settings, such as nursing facilities and mental...more

4/4/2014 - Healthcare Long-Term Care Medicaid

New York State budget negotiations contemplate private equity investment into hospitals…again

Should private equity play a bigger role in New York State healthcare facilities? This is the question facing New York State legislators for the second year in a row....more

3/18/2014 - Healthcare Hospitals Private Equity State Budgets

Colorado pilots an integrated model for the Medicare and Medicaid dual-eligible population

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that Colorado is joining its Financial Alignment Initiative to pilot a managed fee-for-service model for people enrolled in both Medicare and Medicaid...more

3/12/2014 - CMS Fee-for-Service Healthcare Medicaid Medicare

New Budget Deal Can Bring Extension of Medicare Sequestration Cuts

While many in Washington, D.C. are celebrating today the unusual display of bipartisan budgetary comity as the new budget deal is announced, there is a direct and immediate adverse effect for hospitals and physicians. As...more

12/12/2013 - Federal Budget Medicare Sequestration Spending Cuts

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