Where healthcare challenges find solutions
As providers and the government try to lower healthcare costs, much of the action rests on lower reimbursement. Meanwhile, patients increasingly are reaching into their own pockets to cover their healthcare costs. They want price transparency and convenient ways to pay their bills, and providers want to maintain healthy margins. Read more about how payment innovations affect the industry.
Bundled pricing is rare to nonexistent among full-service U.S. hospitals, most of which say they don't know their actual costs for providing care and therefore can't offer such prices. »
The CMS is creating templates and other tools to get states to incorporate upcoming value-based payment models. If other payers sign up, then CMS Administrator Seema Verma hopes more providers will participate.
Insurers claim passing the rebates along to Medicare Part D beneficiaries will ultimately increase premiums or reduce benefits.
The Trump administration's idea to tie Medicare drug spending to other countries' lower prices is popular with progressive Democrats, but can HHS Secretary Alex Azar bring Senate Republicans on board?
The Trump administration is quietly considering allowing states to apply to convert their Medicaid programs into block grants that cap federal spending, which some experts say would lead to lower Medicaid payments for safety-net hospitals.
Health plans clashed with providers and consumers in their reactions to the CMS' proposal to give states more flexibility in regulating the adequacy of provider networks in Medicaid managed-care plans.
Some hospitals have turned to a bold strategy to prevent patients from receiving surprise medical bills from out-of-network providers: requiring in-hospital physicians to contract with the same insurers as the hospital.
The CMS is working to improve a new rule requiring hospitals to post chargemaster prices on their websites after experts said the data wouldn't help consumers, Administrator Seema Verma said Thursday.
The House Oversight Committee set a hearing on high drug prices for the end of January, and lawmakers this week rushed into the drug pricing debate. But the jury's still out on how aggressive Congress will get.
Price transparency stumbled out of the gate last week as hospitals complied with a new CMS requirement to publish their retail charges online for individual services and diagnosis-related groups.
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