Providers push back on insurance cost-cutting hurdles
Editor's Note Escalating administrative hurdles from insurers are heightening tensions between healthcare payers and providers who criticize the measures for threatening patient care, Modern Healthcare reported January 22. According to the article, policies attracting criticism include stringent prior authorization rules, claims denials, and new fees for appeals. For their part,…
HHS report highlights cost, access, quality concerns with private equity in healthcare
Editor's Note Growing consolidation and private equity investments in health care are driving up costs, reducing access, and raising quality concerns, according to a new report from HHS. According to HHS’ January 15 announcement, the report stems from a tri-agency effort by HHS, the Federal Trade Commission (FTC), and the…
Union nurses rally for greater staff, patient protection amid AI rollout
Editor's Note Thousands of RNs nationwide plan to rally in support of safer staff and patients today, January 16, amid widespread introduction of technologies driven by artificial intelligence (AI), according to National Nurses United (NNU). NNU reported on the plans January 14, noting that more than 100,000 members of the…
HHS finalizes rule to expand kidney transplant access
Editor's Note The US Department of Health and Human Services (HHS) finalized a new rule establishing the Increasing Organ Transplant Access Model, a 6-year, mandatory initiative to enhance access to kidney transplants, improve care quality, and reduce disparities. Managed by the Centers for Medicare & Medicaid Services (CMS), the program…
GAO urges HHS to strengthen cybersecurity oversight
Editor's Note A November 13 report from The Government Accountability Office (GAO) identifies critical gaps in the Department of Health and Human Services' (HHS) ability to manage cybersecurity risks in the healthcare and public health sector. HHS, the lead federal agency for cybersecurity in this sector, faces challenges in monitoring…
AHA's Congressional "wish list" calls for financial relief, patient access, workforce protections
Editor's Note In a November 12 letter to Congress, the American Hospital Association (AHA) outlined its priorities for the lame-duck legislative session, focusing on measures to stabilize hospitals and health systems facing significant financial and operational pressures. If enacted, these recommendations would support the nation’s healthcare infrastructure amid rising…
GOP-controlled Senate to prioritize drug pricing, health agency reform
Editor's Note Republicans secured a 51-seat majority in the US Senate after victories in Ohio and West Virginia, promising a power shift that will see GOP leaders shaping decisions on pressing issues like drug pricing, public health agency reform, and rural healthcare. On November 6, STAT published an overview of…
Trump vs. Harris: Key differences in healthcare proposals for Medicaid, Medicare, private insurance, abortion
Editor's Note When it comes to the 2024 presidential election, “Neither candidate addresses a return to the fundamental tenet of healthcare: the patient-physician relationship,” reads the closing line of an “election guide” from Richard Menger MD MPA. In the preceding paragraph, Menger also argues that both candidates also neglect issues…
Medicare Advantage insurers prioritize profits over patients, Senate reports
Editor's Note A Senate report reveals that Medicare Advantage insurers are increasingly prioritizing profits over patient care by ramping up the use of prior authorization to deny necessary services, particularly post-acute care, for older adults, Becker’s Hospital Review reported October 17. In May 2023, the Senate Permanent Subcommittee on Investigations…
CMS proposes $2 Drug List Model to reduce out-of-pocket costs for Medicare recipients
Editor's Note CMS has taken the next steps in making prescription drugs more affordable for Medicare recipients, according to an October 9 report from The US Department of Health and Human Services (HHS). The proposed Medicare $2 Drug List Model, developed in line with President Biden’s Executive Order 14087, aims…
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