Jan 1, 2021 | Managed Care Friday
15: Percent increase in reimbursement starting in February for physicians who do certain procedures in ASCs rather than hospitals under a Michigan Blue plan policy. The change applied to PPO membership, as HMO patients are "managed" and use ASCs more often already. Penn & Tella: This is how my brother-in-law from Boston’s north shore pronounces the magician pair but it’s also a new telehealth program from Penn Medicine that has reduced rehospitalizations 75% among patients who’ve had hip or knee replacements. The program, Home Connect, gives patients wearable devices and text messages to...
Dec 29, 2020 | Drugs, Infusion, Medicare
As expected, a judge in the US District Court in Maryland issued a temporary nationwide injunction halting implementation of the Trump Administration’s Most Favored Nation rule that would have lowered reimbursement for top Part B drugs as of January 1, 2021. Click to read more.
Dec 29, 2020 | Drugs, Pharmacy
In an 8-0 opinion, the Supreme Court ruled that an Arkansas state law regulating PBM pricing is not preempted by federal ERISA law. This opinion overturned lower court rulings but was not a surprise, as the Supreme Court has previously set a relatively high bar for ERISA preemption. Click to read more.
Dec 28, 2020 | Legislation/ Budgets/ Macro, Medicare, Physician Fee Schedule, Physicians
The COVID-19 relief and federal spending bill signed by President Trump on December 27 includes a range of consensus health policies, primarily around transparency and data reporting, as well as minor expansion of provider authorities and consumer-friendly policies. The bill also intervened to mitigate the impact of the evaluation and management services (E&M) budget neutrality adjustment (BNA) on Medicare physician payments. Click here for a summary of the bill Click here for a summary of the E&M BNA impact
