Katie Sullivan

The American Hospital Association (AHA) expressed its opposition to a controversial regulation from the Centers for Medicare & Medicaid Services (CMS) that would purportedly reduce inappropriate hospital admissions.

It's been nearly 1 month since the federal and state health exchanges opened, and enrollment numbers are beginning to roll in.

One of the regulations of the Affordable Care Act is to provide access to free preventive care, but many Americans are discovering that there are coverage exceptions and additional fees that come with certain services.

Cost transparency could change how providers, payers, and patients think about healthcare.

Patients at high risk - including those with cancer, diabetes, and cardiovascular disease - will be covered under the Pre-Existing Condition Insurance Plan (PCIP) until March 31, thanks to a decision this week from the Department of Health and Human Services.

The Department of Health and Human Services (HHS) announced its intention to release Medicare payment data of individual physicians on a case-by-case basis. The agency seeks to publicly impart the information following a 2013 federal court decision that overturned an injunction previously barring the release of physicians' Medicare payments.

Who's purchasing health plans through the insurance exchanges? According to the federal government, more than 2.1 million people have enrolled into private insurance coverage through December, and an additional 1.6 million became eligible for financial assistance under Medicaid.

The newly insured will face barriers to receiving care as they attempt to prove to doctors and pharmacists that they have coverage through the exchanges. In addition, many of those same patients are having difficulty in understanding which doctors are included in their network plans.

Maryland could set a precedent as the Centers for Medicare & Medicaid Services gives approval for a plan that would allow the state to continue setting hospital reimbursement rates for Medicare beneficiaries.

The US Chamber of Commerce says it aims to include the Affordable Care Act in its list of 2014 objectives. Nearly 2 years ago, the chamber voiced its intent to repeal the health reform bill after it was enacted in 2010.

2014 has been identified as the make-or-break year for electronic health records (EHRs). Despite a more than $22 billion federal investment to reward meaningful use of EHR technology, new report findings suggest that the government has failed to put protections in place that would prevent the technology from increasing costs, including through overbilling.

Across the country, Medicaid expansion varies among states. Some experts worried about whether that variation would drive Americans to relocate to other states so that they could obtain better medical coverage. However, those concerns are likely to prove unfounded, according to a recent study from Harvard.

An annual report from the Centers for Medicare & Medicaid Services finds that health spending totaled $2.8 trillion in 2012, which accounted for 17.2% of the nation's gross domestic product (GDP) and was down slightly from the 17.3 % of GDP in 2011.

The Affordable Care Act has been touted as a means to control costs and improve quality of care. One initiative in that effort is to steer patients away from visiting the emergency department (ED). That undertaking may prove to be challenging.

January 2014 has arrived, and with that Affordable Care Act coverage begins. Over the next 12 months, the administration will thoroughly consider the ways in which it can control the rising costs of healthcare in the United States. This is especially true for the nation's Medicare program.

A coverage gap in the Affordable Care Act (ACA) means that many children will not be eligible for dental coverage, which was mandated as one of the 10 essential health benefits for adequate health insurance.

A look back at some of the InFocus blog highlights of 2013.

Starting in January, there will officially be an additional 123 accountable care organizations (ACOs) in the Medicare Shared Savings Program. As providers and hospitals transition to this emerging care model, there is mixed opinion over its longevity.

The value of genetic testing in breast cancer is subject to debate, but it also holds promise. One recent clinical trial simulated by a group of researchers, for instance, found that the 7 single-nucleotide polymorphisms (7SNP) genetic test for breast cancer was cost-effective when used for MRI screenings in patients at intermediate risk of developing the disease over their lifetime.

Enrolling the uninsured continues to be an issue in the federal and state exchanges.

Accountable care organizations (ACOs) might have their year in 2014, if recent survey findings are suggestive of future trends.

A collaborative effort is under way to enroll millions of young and healthy Americans into health plans that are available in the federal and state insurance exchanges. As the enrollment deadline approaches, many individuals aged 19 to 29 years remain unfamiliar with the health reform policy changes. Their participation is imperative to keeping premiums affordable for the higher-risk pool of consumers.

In an effort to avoid a coverage gap in health insurance, those covered under the Pre-existing Condition Insurance Plan (PCIP) will get until January 2014 to enroll into a new plan through the state or federal healthcare exchange website.

Access is an important component of the Triple Aim (cost, quality, access), and it has also been stressed as a significant factor in health reform initiatives. As the influx of uninsured increasingly seeks care, and if the number of providers available to provide primary care decreases as projected, achieving access to quality and cost-effective care may become more problematic.

The Centers for Medicare & Medicaid Services (CMS) recently announced that Stage 2 of the EHR Meaningful Use program would be extended through 2016, especially as many healthcare CIOs continue to struggle with health IT tool vendors. This also means that Stage 3 will be delayed until 2017.

Almost half of 206 hospital executives polled in a recent survey said they do not intend to use an accountable care organization (ACO)-like model in their health systems. Only 20% of those polled currently participate in an ACO.

Several months ago, Kathleen Sebelius, Health and Human Services (HHS) secretary, was asked what success would look like for the state and federal healthcare exchanges. Her response to NBC News was, Well, I think success looks like at least 7 million people having signed up by the end of March 2014. Now, with only an estimated 365,000 having become newly insured through the exchanges to date, some are concerned about meeting enrollment expectations.

In the battle to control costs and out-of-pocket expenses for consumers, it would seem logical that doctors would choose the lower-cost drug. However, a report found that when given the choice, doctors chose the more expensive eye medicine over a lower cost option, even when both prescriptions provided the same effective treatment.

States' refusal to expand their Medicaid programs could cost billions of dollars over the next 10 years, and those costs are staggering.

The transition from volume- to value-based care seems like common sense, yet, there are conflicting opinions regarding what this transition could mean for emergency care, and what measures will truly change practitioner behavior.