Editor's Note Medicare’s first negotiations on 10 top-selling prescription drugs for older Americans will save the US government $6 billion in the first year, according to an August 15 article in Reuters. Enabled by President Joe Biden’s 2022 Inflation Reduction Act, negotiations for drugs used by Medicare—which covers 66 million…

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Editor's Note Medicare and patient out-of-pocket costs are rising as vertical integration results in more procedures moving to hospital outpatient departments (HOPDs) than to ambulatory surgical centers (ASCs), Becker’s ASC Review reported on August 8. The article summarizes a study published July 25 in Science Direct. Described as "physician vertical…

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Editor's Note The Supreme Court’s recent “Chevron” ruling could offer additional financial security to hundreds of so-called "tweener" rural hospitals—those too large to be considered critical access hospitals but too small to be rural referral centers. Modern Healthcare reported the news July 29. According to the article, critical access hospitals,…

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Some 800,000 knee replacements and 550,000 hip replacements are performed in the US each year. Factoring in the ever-expanding aging population, projections show the figure for knee replacements alone will explode to 3.5 million procedures being done annually by 2030—and that is just one type of procedure within a single…

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Editor's Note On July 10, CMS proposed Medicare payment rates for hospital outpatient and ambulatory surgery center (ASC) services for 2025.  Published annually, the Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Proposed Rule will have a 60-day comment period, which this year ends September 9 prior to…

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Editor's Note Private payers initially deny reimbursement on 15% of claims, only to later approve more than half of those initial denials, according to a national survey of healthcare institutions published March 21 by Premiere, Inc. Additionally, the denied claims on average tend to be more prevalent for higher-cost treatments…

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Editor's Note Older Americans are at heightened risk for both short-term and long-term hospital readmission following major surgery, according to a study from Yale University published February 28 in Jama Network Open.   Readmission places a major financial strain on health systems, researchers write, pointing out that the total cost…

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Editor's Note Research shows that Americans who live in areas with a limited number of primary care doctors and nurse practitioners are at a greater risk for emergency surgeries and complications. The findings were published March 4 in the journal Health Affairs.  For the study, researchers looked at Medicare patient…

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Editor's Note The healthcare spending burden of Medicare households was double that of non-Medicare households in 2022, according to an analysis published by KFF (Kaiser Family Foundation) on March 14.  Using data from the Consumer Expenditure Survey, KFF found that average health-related expenses made up 13.6% of Medicare households’ total…

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Editor's Note Although few strategies for reducing readmission rates leverage nurse input, nurses are well-placed to identify patients most at risk, according to a study published in the March issue of the journal Medical Care. The authors note that older Medicare beneficiaries with multiple chronic conditions (MCCs) continue to experience…

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