Exterior of the Federal Trade Commission (FTC) in Washington, D.C.
FTC Chair Makes Clear Hospital Consolidation Hurdles
Tag Archives: ACA
US uninsured rate hits all-time low in 2015
http://www.healthcaredive.com/news/us-uninsured-rate-hits-all-time-low-in-2015/419381/
Of course, the uninsured rate only tells part of the story. Debate continues over whether coverage under the ACA has sufficiently equated to accessibility and affordability of care, and just how much premiums are likely to balloon in 2017.
Feuding HIEs Pit Cerner vs. Epic Loyalists in Missouri
Don’t panic about House v. Burwell.
The Affordable Care Act obligates the federal government to reimburse health plans for cutting their low-income customers a break on their out-of-pocket payments. Whether or not there’s an appropriation for the cost-sharing reductions, that statutory obligation is enforceable in court—specifically, in the Court of Federal Claims.
Health plans that get stiffed can therefore sue the federal government for the cost-sharing reductions. Winning those cases should be easy: the plans will just have to show that they’re owed money under the ACA. And here’s the kicker: Congress has permanently appropriated the money to pay court judgments, even if it hasn’t appropriated money for the cost-sharing reductions.
The right question isn’t whether health plans will get paid. It’s when.
High Stakes Payment Reform Comes with High Hopes
The most ambitious attempt in a generation to redesign the way physicians are paid for providing services to Medicare beneficiaries is a work in progress.
A government defeat in House v. Burwell
Having previously held that the House of Representatives has standing to sue, the district court in House v. Burwell has now held that the Obama administration is violating the Appropriations Clause in making cost-sharing payments under the ACA in the absence of the requisite congressional appropriation. The court has stayed its decision pending appeal, meaning that it won’t take immediate effect. Indeed, I suspect it will never take effect.
Aetna Not Withdrawing From Any Health-Law Insurance-Exchange States
Insurer says it may expand into new geographies for exchange health plans.
Performance measures put heat on hospitals
http://www.healthcaredive.com/news/performance-measures-put-heat-on-hospitals/418477/
This year has seen a bevy of new programs and initiatives aimed at moving providers toward a value-based model of care.
The Tangled Hospital-Physician Relationship
Medicare’s New Physician Payment System
http://www.rwjf.org/en/library/research/2016/04/medicare-s-new-physician-payment-system.html
Government and private-sector leaders have resolved to transform how physicians are paid in a way that holds them more accountable for the care they deliver.
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf428568
HENRY KOTULA 