Tag: Medicare

RAND study reveals private payers pay 250% more than Medicare for healthcare services

Editor's Note A recent analysis by the RAND Corporation, a research and analysis nonprofit, revealed a disparity between hospital and ambulatory surgery center (ASC) prices paid by employers and private payers compared to Medicare prices, Revcycle Intelligence May 15 reports. The study, covering data from 2020 to 2022, showed private…

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By: Tarsilla Moura
May 22, 2024
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Getting ready for the OAS CAHPS Survey 2025 requirement

Editor's Note Starting in 2025, Medicare-certified ambulatory surgery centers (ASCs) will be required to participate in the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey to comply with the ASC Quality Reporting Program, reports the Ambulatory Surgery Center Association (ASCA) and Outpatient Surgery Magazine…

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By: Tarsilla Moura
April 24, 2024
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Federal regulations require written consent for pelvic exams at hospitals, medical schools

Editor's Note New federal guidelines require obtaining written informed consent before conducting pelvic and other sensitive medical examinations, according to an April 2 Associated Press report. The new guidance from the US Department of Health and Human Services focuses specifically on medical students, nurse practitioners, and physician assistants performing breast,…

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By: Matt Danford
April 15, 2024
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Annual CMS rules support underserved, under-resourced communities, promote value-based care

Editor's Note Addressing social determinants of health (SDOHs), strengthening emergency preparedness, and improving maternal heath are among the top priorities of the fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) rules released April 10. These and other efforts aim to…

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By: Matt Danford
April 12, 2024
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Private payers profit by delaying medical claims

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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By: Matt Danford
April 4, 2024
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Study: Postoperative hospital readmissions higher for older Americans

JAMA (healthcare publication) Network logo

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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By: Brita Belli
March 27, 2024
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How data puts the ‘value’ in value-based care

What if a surgeon decided to perform a procedure on a patient that was not totally necessary? It happens more often that one might realize. As recently as August 2023, Forbes published an article that cited a Harvard Business Review report stating that over 50% of lumbar spine surgeries are…

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By: David Cotriss
March 22, 2024
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Lack of primary care physicians tied to emergency surgeries

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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By: Brita Belli
March 19, 2024
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Medicare households have double the healthcare spending burden

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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By: Brita Belli
March 19, 2024
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Federal probe investigates care quality impact of private equity mergers, acquisitions

Editor's Note Making good on plans announced by the Biden administration in December, federal agencies have launched a public inquiry into how private equity mergers and acquisitions impact patient outcomes, worker safety, and healthcare access and costs, including costs to taxpayers.  As reported by Dotmed Healthcare Business News on March…

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By: Matt Danford
March 14, 2024
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