Where we’re going

On September 18, 2020, RAND Corporation released its Nationwide Evaluation of Health Care Prices Paid by Private Health Plans “designed to allow an easy comparison of hospital prices using a single metric.”[1] This was Round 3 of its employer-led transparency initiative. Round 3 evaluated data from 2016 to 2018 from 49 of 50 states and … Continued

KaufmanHall, a consulting services and software provider to 80 of the 100 largest health systems in the United States, recently published an article entitled, “The Effect of COVID-19 on Hospital Financial Health.”[1] “For any organization, a positive operating margin is essential for long-term survival. Few organizations can maintain themselves for an extended period when total … Continued

On August 25, 2020, the Centers for Medicare & Medicaid Services (CMS) promulgated regulatory changes via an interim final rule dated August 21, 2020,[1] requiring nursing homes to test staff and offer testing to residents for COVID-19. Laboratories and nursing homes using point-of-care testing devices will be required to report diagnostic test results as required … Continued

As if the standard issues facing businesses related to healthcare were not enough, businesses now have to deal with the COVID-19 pandemic. As it was, annual premiums were on the rise – increasing 5% in 2019 and predicted to increase 6% in 2020.[1] The health care costs related to COVID-19 are immense. Kaiser Family Foundation … Continued

Section 1332 of the Affordable Care Act (ACA) allows states to apply for a State Innovation Waiver to pursue innovative strategies for achieving high quality, affordable health insurance and to to alter key ACA requirements in the individual and small group insurance markets in furtherance thereof. A January 7, 2020 Kaiser Family Foundation article reported … Continued

Before the onset of COVID-19, there existed a seller’s market for businesses. Clean, profitable businesses were in short supply. An abundance of private equity and historically low interest rates drove multiples to levels this author had not previously seen in his 40-year legal career. Good businesses in even mundane sectors might sell for 10 times … Continued

In November 2019, the Centers for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services, issued a Rule entitled Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates. Price Transparency Requirements for Hospitals … Continued

Surprise medical billing has been a key issue targeted by legislators across the country, including by the U.S. House and Senate. Surprise medical bills arise when a patient inadvertently receives care from an out-of-network provider, such as when a patient seeks care at an in-network facility and is treated by an out-of-network provider (e.g. an … Continued

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”). The CARES Act has many components, one of which was to make $175 billion in Provider Relief Funds available to hospital facilities and other medical providers. To use the funds, the hospitals and providers must … Continued

Good reliable data is necessary for public authorities, aided by medical professionals, to formulate sound strategies for dealing with COVID-19. An understanding of the progression of the pandemic, infection rates, death rates, and other data points will drive community efforts, treatments, outcomes, and economic decisions. But do we have good data concerning COVID-19? What is … Continued