Axios

Cutting-edge medical devices will be eligible for Medicare coverage while manufacturers continue to gather data on how they perform under a new plan finalized by the Biden administration Wednesday. Why it matters: The long-awaited plan offers America's seniors access to new technologies that have been cleared by the Food and...

Cutting-edge medical devices will soon be covered by Medicare

As the Medicare Advantage landscape evolves, the success of health systems hinges on their ability to adapt and excel in key areas such as star ratings and appropriate coding. Health systems' greatest opportunity is to enter into full-risk arrangements with health plans, shifting the focus from managing illness to maintaining wellness. However, many systems have not made the necessary investments to thrive in this value-based care model, often missing out on its potential benefits and driving ambivalence toward the MA program, according to SCAN Group CEO Sachin Jain, MD.

Where health systems are going wrong with Medicare Advantage

The FDA has given 510(k) clearance to Huxley Medical's sleep apnea diagnostic patch, SANSA. The device is an at-home diagnostic tool that uses signal processing technology and AI to measure "blood oxygen saturation, EKG-derived heart rate, respiratory effort, chest movement, sleep staging, snoring, body position and actigraphy," according to an Aug. 7 news release from Huxley Medical.

Sleep apnea patch receives FDA clearance

HIT Consultant 

– The U.S. Department of Health and Human Services (HHS) announced the final rule for Medicare payments and policies for inpatient hospitals and long-term care hospitals (LTCHs) for fiscal year (FY) 2025. – The FY 2025 IPPS and LTCH PPS rule focuses on improving health outcomes, addressing social determinants of...

CMS Finalizes Medicare Payment Rule for Hospitals, Focuses on Equity, Safety, and Innovation

Medicare Advantage customer service supports a less healthy, higher-need population, indicating that it should be designed and staffed to effectively serve complex, high-need patients. ABSTRACT. Objectives: To examine characteristics of Medicare Advantage (MA) enrollees who use their plan’s customer service to help plans understand how to better meet members’ needs....

Medicare Advantage Customer Service Is Used Most by Higher-Need Patients

NBC News

After private-equity firms acquire hospitals, the facilities’ assets and resources diminish significantly, leaving the facilities less equipped to care for patients, according to a new study by physician researchers at the University of California at San Francisco, Harvard Medical School and the City University of New York’s Hunter College.

After private equity takes over hospitals, they are less able to care for patients, say top medical researchers

San Diego, CA

The process of seeking care for your elderly loved one can be confusing as there are so many options and their needs evolve as they age and their age-related symptoms progress. As the founder and proprietor of a home-based Residential Care Facility for the Elderly (RCFE) in San Diego called...

When is it Time for a “Home-Based” Residential Care Facility for the Elderly (RCFE)?

In a Wednesday interview with CNBC's Jim Cramer, CVS CEO Karen Lynch said she is taking responsibility for the company's Aetna insurance business after the most recent quarter missed expectations. "I'm taking direct ownership and am going to focus on the financial and operational execution of that business," she said.

CVS CEO says she's 'taking direct ownership' to fix Aetna insurance business

HealthPartners, a prominent healthcare provider, has announced plans to withdraw from the Medicare Advantage plan offered by UnitedHealthcare starting in 2025. This decision will affect approximately 30,000 patients and marks a considerable shift in the relationship between the two healthcare giants. A potential coverage gap is anticipated for the affected...

HealthPartners to exit UnitedHealthcare’s Medicare plan in 2025

The FDA has approved the first nasal spray to treat anaphylaxis. The epinephrine nasal spray, called neffy, is for emergency treatment of allergic reactions, including anaphylaxis, in adult and pediatric patients weighing approximately 66 pounds or more, according to an Aug. 9 news release from the agency. The approval is...

FDA approves 1st anaphylaxis nasal spray

UnitedHealthcare will launch a national program Oct. 1 for physicians to override traditional prior authorization requirements. The gold card program, which applies to commercial, individual exchange and Medicare Advantage plans, allows certain physician practices to not submit prior authorization requests for “certain medical, behavioral and mental health services,” according to a fact sheet released by the company.

UnitedHealth institutes gold card program to address prior authorization concerns

New York State

Who: A New York man has filed a revised class action lawsuit against Coca-Cola and its subsidiary Simply Orange Juice Co. Why: The plaintiff says the company sells juices that contain PFAS, otherwise known as forever chemicals. Where: The Simply Orange PFAS class action lawsuit was filed in a New...

Revised class action says all Simply Orange juice products contain PFAS

Florida State

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Akeena

Red Lobster, the popular seafood chain, has confirmed additional closures in Florida, adding to its recent wave of shutdowns following the company’s bankruptcy filing in May. The latest round of closures includes two more Florida locations, highlighting the ongoing struggles of the iconic restaurant chain.

Popular seafood chain announces more closures in Florida

UnitedHealthcare will launch a national gold-card program Oct. 1 for providers that consistently adhere to evidence-based guidelines to bypass prior authorizations for some medical services. Five things for spine and orthopedic surgeons to know:. 1. Under the new program, gold card practices will simply complete an advanced notification for the...

UnitedHealthcare to begin national gold-card program: 5 notes for spine surgeons

Dicle Belul

Medicare Advantage has experienced an increase in denied prior authorization requests in recent years, with 7.4% of requests being denied in 2022, up from 5.8% in 2021. This trend is concerning for seniors relying on Medicare Advantage for their healthcare needs. The denial of prior authorization requests can lead to frustration and obstacles in accessing necessary treatments and services. While prior authorization is intended to ensure the medical necessity of a service, some seniors feel their needs are being unfairly rejected.

Rising Denials in Medicare Advantage Impede Senior Care

Georgia State

Seven insurers are exiting Medicare Advantage markets in 2025, a number that is likely to grow in the fall. There are 3,959 Medicare Advantage plans available nationwide in 2024. The average number of plans available to beneficiaries is 43, unchanged from 2023. Seven insurers exiting Medicare Advantage markets in 2025:

7 payers exiting Medicare Advantage markets in 2025

Ohio State

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The Lantern

On Tuesday, licensed Ohio dispensaries began legally selling non-medical marijuana to consumers; however, the drug’s possession, growth and/or usage are still prohibited on Ohio State’s campus. Credit: Jefferee Woo/Tampa Bay Times/TNS [Original caption: Four citizen-led petitions with proposals to update Dallas’ charter hit the 20,000 valid signature threshold to make it on the Nov. 5 election ballot, including one that would ban police officers from arresting or citing people carrying less than four ounces of marijuana.] As of Tuesday, students 21 and older can now legally purchase marijuana in Ohio.

Dispensary sales of recreational marijuana began Tuesday; possession and usage still prohibited on Ohio State’s campus

Kansas State

Pittsburg, KS

Drew Talbott, president of Via Christi Hospital in Pittsburg, Kan., will retire Aug. 30, one day before the hospital transitions to ownership by St. Louis-based Mercy. Mr. Talbott joined Via Christi in 1996 and has been president for four years, according to an Aug. 6 news release shared with Becker's by St. Louis-based Ascension. He was previously its COO for 13 years.

Ascension Kansas hospital president to retire

Premature babies born at 22 weeks are a "gray zone" for hospitals, which must decide whether or not to offer treatment, The Wall Street Journal reported Aug. 7. There is general consensus that babies born at 25 or 26 weeks can and should be treated, and those born at 20 weeks or less are too small to save, but in between is a "gray zone." About 8,000 infants are born between 22 and 24 weeks gestation in the U.S. each year and most can only be treated at level 3 or 4 NICUs.

Extremely premature babies a gray zone for hospitals: WSJ

Great Falls, MT

Montana Free Press

The state’s largest nursing home plans to close its doors weeks after being terminated from the federal Medicare and Medicaid program after “a history of serious quality issues” and violations for deficient patient care. In a recent public notice, the Centers for Medicare and Medicaid announced that...

State’s largest nursing home prepares to close following patient safety violations

NewsBreak

CMS finalizes rule for breakthrough devices

CMS has finalized a rule intended to improve access to breakthrough medical devices for people with Medicare. The Transitional Coverage for Emerging Technologies...

CMS finalizes rule for breakthrough devices

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