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Industry News

Nov 16, 2018
More targeted enforcement actions by the CMS has led to the lowest improper payment rate for Medicare in nearly a decade, according to new federal data.

The CMS doled out an estimated $31 billion in improper payments in fiscal 2018, which is around 8.12% of all claims paid during that period, according to a report issued Friday. That's down from $36.2 billion or 9.51% of Medicare claims in fiscal 2017.

Improper payments include fraudulent claims, payments distributed to the wrong...

Nov 16, 2018

Cleveland Clinic implemented an entire supply chain and treatment protocol for one drug to ensure that it is not wasted.

The U.S. Food and Drug Administration approved Biogen's Spinraza, the first drug it cleared to treat spinal muscular atrophy, about two years ago. The first year's supply of the potentially lifesaving therapy is about $750,000, and then $375,000 a year thereafter, said Jeffrey Rosner, senior director of pharmacy contracting and purchasing at Cleveland Clinic.

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Nov 16, 2018
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.

Welcome back to the Friday Breeze! Brace yourself, because with the midterms in the rear-view mirror (psshh, the 2018 elections are so five minutes ago), lawmakers, hopefuls and sideline experts are all barreling toward 2020. (I have only just this...

Nov 16, 2018
Geisinger Health system this week plans to "redesign" its surgical program with a goal of improving pain management and reducing opioid prescribing after surgical procedures.

The Pennsylvania-based health system Thursday announced a new program that will implement best practices developed over a yearlong pilot project across 42 of its surgical procedures. The goal of ProvenRecovery is to expand to 100 procedures by the end of 2019.

Results of the pilot, which kicked off in June 2017...

Nov 16, 2018

Update at 3:30 PM CT

Partners HealthCare and Harvard Pilgrim Health Care are tabling their planned merger after executives reportedly felt the deal was getting too complicated.

Boston-based Partners, Massachusetts' dominant health system, and Wellesley, Mass.-based Harvard Pilgrim, the state's second-largest health plan, announced in May they were considering a possible merger. On Friday, the not-for-profit companies confirmed the merger talks were on hold.

"Our...

Nov 16, 2018

Nearly one year after Illinicare, a private insurer in the state's overhauled Medicaid managed-care program, slashed reimbursement rates to medical suppliers, a large provider is terminating its contract with the insurer.

Cuts of up to 50 percent, which took effect Jan. 1, hit suppliers that provide Medicaid beneficiaries with durable medical equipment like wheelchairs and ventilators.

Minneapolis-based ActivStyle, which specializes in incontinence products, decided to exit...

Nov 16, 2018

LifePoint Health is officially merged with RCCH HealthCare Partners, the companies announced Friday.

Affiliates of private equity firm Apollo Global Management, which owns RCCH, are purchasing LifePoint, a Brentwood, Tenn.-based rural hospital operator. They're paying LifePoint shareholders $65 per share in cash, representing a premium of about 36% to LifePoint's closing share price on July 20, the last trading day prior to the merger's announcement.

As a result of the deal's...

Nov 15, 2018

Publicly-traded precision medicine company NantHealth more than doubled its net loss in the third quarter as its CEO said the company is struggling to get reimbursed for its genetic cancer tests.

Culver City, Calif.-based NantHealth's net loss was $97.5 million in the quarter that ended Sept. 30, up from $42.4 million at the same period in 2017. Total net revenue was $22.3 million in the quarter, up 2.4% from the prior year, in which it was $21.8 million. The company's gross profit...

Nov 15, 2018

A new report from Fitch Ratings raises a question that's likely been on the minds of many who follow the not-for-profit hospitals and health systems: Has acute-care profitability begun a permanent decline?

Yet, even as those providers' margins have slid steadily downward in the past three years, their balance sheets are at an "all-time high," said Kevin Holloran, a senior director with Fitch Ratings.

"So it's like, 'Are we coming or are we going?' We're actually doing a...

Nov 15, 2018

Office visits to primary-care physicians have plummeted despite the expectation that frequent checkups with primary-care doctors improve a person's health and lower costs, new research shows.

Primary-care physicians saw 18% fewer patients from 2012 to 2016, according to new analysis from the Health Care Cost Institute that compiled data from Aetna, Humana, Kaiser Permanente and UnitedHealthcare. There has been a relatively steady decline in primary-care visits for adults under 65...

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