The antitrust settlement will resolve allegations that Sutter Health engaged in anticompetitive practices, resulting in higher healthcare prices for self-funded plan members. A Superior Court of California judge has granted preliminary approval for a $575 million antitrust settlement Sutter Health proposed to resolve a case alleging that it engaged in anticompetitive practices that drove up healthcare prices in Northern California. The Sacramento-based health system reached the settlement agreement over a year ago with plaintiffs, including California Attorney General and current HHS Secretary nominee Xavier Becerra and the United Food and Commercial Workers International Union (UEBT). The settlement agreement will now be heard by a court for final approval on July 19, 2021. The settlement resolves a class action lawsuit brought on by UEBT in 2014 claiming that Sutter’s anticompetitive business practices caused them to pay more for healthcare items and services than necessary. Attorn...

Nearly two-thirds of the largest hospitals in the US have yet to fully comply with the new price transparency rule, with most missing payer-specific charges. Many of the largest hospitals in the country are still not complying with a new price transparency rule that went into effect on Jan. 1, 2021, according to a new analysis . Nearly two-thirds of the 100 largest hospitals in the US by certified bed count did not meet all the requirements of the new rule, including posting payer-specific negotiated charges on their websites, by early February 2021, researchers from Hilltop Institute, a nonpartisan research organization at the University of Maryland, recently reported in the Health Affairs blog. What’s more, just 22 percent of the hospitals in the analysis appeared to be fully compliant with the rule’s requirements, with some even exceeding the regulation in terms of the amount of pricing information they shared on public websites. Researchers deemed hospitals compliant if their files...

Medicare reimbursement rates will nearly double for the administration of single- and two-dose vaccines. CMS has significantly increased Medicare reimbursements rates for the administration of new COVID-19 vaccines in an effort to accelerate rollout, according to a new announcement. The announcement emailed to journalists earlier today states that the national average payment rate for physicians, hospitals, pharmacies, and other immunizers has risen from approximately $28 to $40 for the administration of single-dose vaccines and from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. Although, the exact reimbursement rate for each dose of a COVID-19 vaccine will depend on the type of entity that administers the vaccine and where the vaccination is furnished. The new rates will apply to vaccinations given on and March 15, 2021. “This new and higher payment rate will support important actions taken by providers that are designed to increase the numb...

Summary What is already known about this topic? Use of telehealth (the remote provision of clinical care) early during the COVID-19 pandemic has not been well characterized. What is added by this report? The 154% increase in telehealth visits during the last week of March 2020, compared with the same period in 2019 might have been related to pandemic-related telehealth policy changes and public health guidance. What are the implications for public health practice? Telehealth could have multiple benefits during the pandemic by expanding access to care, reducing disease exposure for staff and patients, preserving scarce supplies of personal protective equipment, and reducing patient demand on facilities. Telehealth policy changes might continue to support increased care access during and after the pandemic.Article Metrics  Altmetric: News (2) Twitter (149) Facebook (1) Citations: Views:Views equals page views plus PDF downloads Metric Details Figure 2 References   Related Ma...

In order to succeed with healthcare bundled payments, providers must engage post-acute care providers, leverage data analytics, and improve their patient engagement strategies. Healthcare bundled payments are a value-based reimbursement model that uses a single, comprehensive payment to address an entire defined episode of care. This alternative payment model has become a critical stepping stone for providers as they explore risk-based purchasing. Unlike other common alternative payment models, such as accountable care organizations (ACOs) and capitation, bundled payments impose clinical and financial responsibility on providers for a single care episode for an individual rather than the ongoing outcomes of an entire patient population. If total care costs for the episode are below the bundled payment reimbursement, providers generate a profit. However, if total costs exceed the bundled payment amount, providers incur a financial loss. Additionally, providers may earn value-based ince...

Practices who fail to be proactive about collecting from patients will predictably experience a tsunami of accounts receivable. In most states, medical practices are re-opening and ramping up patient volume. Appointments and procedures are increasing, and physicians are eagerly anticipating an increase of cash flow compared to the past three months. However, the dismal unemployment numbers suggest that patient balances will be increasingly difficult to collect. Here are seven ways to increase patient payments. https://www.physicianspractice.com/view/7-ways-to-increase-patient-payments

Health systems are facing a mean subsidy, or loss, of $227K per employed physician, while hospitals continue to underperform due to COVID-19, Kaufman Hall reports. The ongoing COVID-19 pandemic is creating a perfect storm for health systems, which appear to be taking hits on both the hospital and physician practice sides of their business. The latest National Hospital Flash Report from consulting firm Kaufman Hall found that the median hospital operating margin index is well below 2019 performance at 2.7 percent year-to-date through September even with federal aid from the Coronavirus Aid, Relief, and Economic Security (CARES) Act funding. Without CARES Act funding, the median hospital operating margin index is -1.9 percent. Additionally, the Kaufman Hall earnings before interest, taxes, depreciation and amortization (EBITDA) margin index was well below 2019 performance, standing at 7.5 percent year-to-date with CARES Act funding and 3.2 percent without funding from the CARES Act. Mea...