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

New York State

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Dicle Belul

Democratic U.S. Congressman Pat Ryan of New York has proposed the Improving Access to Emergency Medical Services for Seniors Act, aiming to introduce at-home care services under Medicare coverage. The bill advocates for a "treatment-in-place model" to provide minor health issue treatment at home, eliminating the need for Medicare patients to be transported to hospitals for reimbursement. This change attempts to alleviate the financial burden on taxpayers and recognizes the essential role of emergency medical service providers.

Expanding Medicare: Enhancing Care for Seniors

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

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Bucks County Beacon

Conservatives have done the United States a huge favor by explaining in detail what they’ll try to do if Donald Trump is reelected. Project 2025 , a “presidential transition project” of the Heritage Foundation, helpfully lays out how a group of former Trump officials would like to transform the country into a right-wing dystopia where the rich thrive and the rest of us die aspiring to be rich.

Project 2025’s Plan to Gut Medicare and Medicaid

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

UnitedHealthcare will launch its national gold-card program on Oct. 1. The program will reward contracted provider groups that "consistently adhere to evidence-based care guidelines," according to an Aug. 1 policy update from UnitedHealthcare. The program will apply to all UnitedHealthcare commercial, individual exchange, Medicare Advantage and community plans. The payer...

UnitedHealthcare launching national gold-card program

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

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

“Private Medicare plans now cover more than half of Medicare beneficiaries, but how well they actually serve people differs from county to county,” Maya Goldman writes over at Axios. “Medicare enrollees living in communities of color and with high rates of poverty had less access to top-rated Medicare Advantage plans last year than those living in wealthier places that are majority white. These disparities could contribute to unequal health outcomes for seniors across the country as Medicare Advantage enrollment grows, particularly among seniors from diverse and low-income backgrounds. The geographic quality differences in Medicare availability drive home the longstanding point that where someone lives in America can determine the caliber of their health care options. ‘Nobody can really easily move to another location to get the health care services they need,’ said Jeannie Fuglesten Biniek, associate director of KFF’s program on Medicare policy. ‘It’s even harder for people who are Medicare beneficiaries.’ … Medicare Advantage plans offered in more disadvantaged counties were less likely to be rated 4.5 stars or higher, according to research published last week in JAMA Network Open.” Maya Goldman, “Medicare Advantage’s geographic disparities,” Axios.

Medicare Advantage worse in some places

Two new studies suggest that free colonoscopies –– covered under CMS provisions set in 2023 –– not only save lives, but also money for both Medicare and private payers. The study, published in Cancer Research Communications and Populations Health Management, found that the new benefit saved...

Free colonoscopies save CMS, private payers money: Study

As dementia-related illnesses continue to rise among hospice patients, caregivers and providers alike are working judiciously to best find ways to support patients and their families in navigating these new diagnoses. In July 2023, the U.S. Centers for Medicare & Medicaid Services (CMS) unveiled a newly planned demonstration for those...

Why Palliative Care Providers Are Adopting the GUIDE Model

Decatur, IN

The gap between hospitals with strong and weak margins is growing, according to Kaufman Hall, and the top hospitals are vigilant about evaluating their physician strategies. "Data from the National Hospital Flash Report show that not all hospitals are generating losses; higher performing organizations are carefully reviewing their employed physician portfolios with a focus on profitable service lines and are more effective at deploying advanced practice providers," stated the research firm in the second quarter Physician Flash Report, released Aug. 5.

What top financially performing hospitals do differently with physicians

The U.S. Centers for Medicare & Medicaid Services (CMS) on Tuesday finalized its 2025 hospice payment rule, but some say that the base rate increase is insufficient in today’s environment. CMS approved a 2.9% raise in per diem hospice payments, which is higher than the 2.6% the agency initially...

Hospice Community Responds to CMS 2025 Hospice Rule

Florida State

Uncovering Florida

Most people are guilty of doing it at least once in their lives, many people do it by accident, some do it because they find it fun, and others do it for reasons like honoring loved ones. Regardless of the situation, just about everyone has released a balloon. The difference is that intentionally releasing balloons is now illegal by House Bill 321’s standards.

Law Signed By DeSantis Makes It Illegal To Release Balloons In Florida

With hurricane season posing a consistent threat six months out of the year, who would not like a little help getting their home ready for the harsh weather to come? Senate Bill 7028: My Safe Florida Home Program, approved by Governor DeSantis on April 24, 2024, and effective as of July 1, appropriates a one-time total of $200 million from 2024 to 2025 for the purpose of funding hurricane mitigation grants and inspections, as well as outreach and administration costs, to support homeowners in Florida.

DeSantis Signs New Bill Giving $200 Million To Homeowners

Massachusetts State

When Dallas-based Steward Health Care shared plans to close two of its Massachusetts hospitals and lay off 1,243 employees, its CEO, Ralph de la Torre, MD, was in France at Versailles for the equestrian 2024 Olympic events, according to the Boston Globe. The Aug. 7 opinion piece, authored by former...

Eyes stay on Steward CEO amid France trip

Denver, CO

David Heitz

More dangerous substances are entering the Denver drug supply, Harm Reduction Action Center warned in a newsletter this week. “The Iron Law of Prohibition posits that as law enforcement becomes more intense, the potency of prohibited substances increases,” HRAC Executive Director Lisa Raville wrote in the newsletter. That is exactly what is happening, she said.

Dangerous substances entering Denver drug supply

DME in healthcare stands for durable medical equipment – defined by CMS as equipment that is used for medical purposes by an individual who is sick or injured and that can withstand at least three years of repeated or frequent use. However, in the context of healthcare compliance, it can be more important to understand the HIPAA status of DME suppliers.

What Does DME Stand For in Healthcare?

Walgreens shared in an Aug. 7 Securities and Exchange Commission filing that it could sell off its entire stake in primary care clinic chain VillageMD. "The company is currently evaluating a variety of options with respect to VillageMD in light of ongoing investments by the company in VillageMD’s businesses and VillageMD’s substantial ongoing and expected future cash requirement," the filing said. "These options could include a sale of all or part of the VillageMD businesses, possible restructuring options and other strategic opportunities."

Walgreens eyes offloading all of VillageMD

North Carolina State

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Town Talks

In North Carolina, the divorce process can be challenging, particularly due to the mandatory one-year separation requirement. This law mandates that couples must live separately for at least a year before filing for divorce, a rule that can be frustrating for many.

You might be granted a divorce in North Carolina if your spouse is ‘incurably insane.’ Here’s how

NewsBreak

Telehealth access for Medicare patients in limbo

It is anticipated that Congress will extend telehealth access rules for Medicare patients, though likely not until after the election. This delay could have significant repercussions,...

Telehealth access for Medicare patients in limbo

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