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Industry News

Feb 15, 2019

ORLANDO, Fla.—For as much as the CMS tries to move away from it, the phrase “meaningful use” continues to hang over the agency's information technology agenda.

While the release of proposed regulations last week to bolster data exchange generally got a positive response at HIMSS19, industry stakeholders stressed the need for sharing relevant—meaningful—information.

“There's patient access to non-administrative data and access to clinical-level,” said Nader Mherabi, senior vice...

Feb 15, 2019
Feb. 18: It's the deadline for providers and payers to send information to a bipartisan group of senators asking for information on surprise medical billing. Earlier this month, Sens. Bill Cassidy (R-La.), Michael Bennet (D-Colo.), Todd Young (R-Ind.), Tom Carper (D-Del.), Lisa Murkowski (R-Alaska) and Maggie Hassan (D-N.H.) asked the industry to share data they hope sheds light on why consumers receive unexpected bills. The senators asked insurers to outline what they pay for out-of-network...
Feb 15, 2019
To get healthcare's powerful players to behave as desired, HHS and its various units are increasingly turning to the same playbook: naming and shaming bad actors.

Most recently, the CMS and the Office of the National Coordinator for Health Information Technology issued two proposed rules on Feb. 11 to spur interoperability and counter information-blocking.

Among the rule's provisions is to post a list online of healthcare clinicians and hospitals that block the transfer of patient...

Feb 15, 2019
The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

Happy Friday! Did you guys get as big a kick out of the #healthpolicyvalentines hashtag as I did? (I feel I’m talking to the right crowd here.) They’re quite delightful, including this timely one from KHN’s own Rachel Bluth: “Not even a PBM could...

Feb 14, 2019

The drugmaker Gilead Sciences has been hit with a whistle-blower suit accusing it of paying healthcare providers, government agencies and others organizations to boost sales of its hepatitis and HIV drugs.

In an unsealed False Claims Act case in California federal court, a whistle-blower claimed Gilead's Frontlines of Communities in the United States program, which partners with other institutions to facilitate hepatitis and HIV screenings, resulted in billions of dollars in excess...

Feb 14, 2019
A federal jury decided Tuesday that insurer Blue Shield of California underpaid a California hospital system for emergency medical services provided to Blue Shield's members.

The jury in the U.S. District Court in San Francisco determined that Blue Shield must pay out-of-network NorthBay Healthcare Group 67% of its billed charges since the end of 2016. King & Spalding, the law firm representing NorthBay, estimated that it would recover more than $16 million, but the exact amount has not...

Feb 14, 2019

Even as it held a steady operating margin, Baylor Scott & White's profit took a hit in the first six months of its fiscal 2019 on weak investment returns.

The Dallas-based not-for-profit health system reported Thursday it generated an excess of revenue over expenses of $267.7 million in the six months ended Dec. 31, 2018—the first half of its fiscal 2019—down 55% over the prior-year period, when it was $595.5 million. Meanwhile, the system's operating margin ticked up slightly to...

Feb 14, 2019

Republicans are still in charge of the White House and the Senate, but the “Medicare-for-all” debate is in full swing. Democrats of every stripe are pledging support for a number of variations on the theme of expanding health coverage to all Americans.

This week, KHN’s “What the Health?” podcast takes a deep dive into the often-confusing Medicare-for-all debate,...

Feb 14, 2019

DaVita's profit took a hit in 2018 as the company works to close on the sale of its medical group to UnitedHealth Group.

Net income attributable to the Denver-based dialysis provider was $159 million in 2018, compared with $664 million in 2017, according to the company's results. DaVita saw a net loss of nearly $150 million in the fourth quarter of 2018, compared with net income of $303 million in the fourth quarter of 2017.

The company generated operating income of $1.5...

Feb 14, 2019

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As calls for “Medicare-for-all” grow louder among Democrats in Congress, Democratic governors and mayors have been pushing ahead with urgency to corral medical costs and bring health care to those who remain uninsured.

KHN senior correspondent Sarah Varney and “PBS NewsHour” producer Jason Kane filed this report on legislative initiatives pushed by California Gov. Gavin Newsom and New York City Mayor Bill de Blasio, among others...