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What We're Reading: States to Recalibrate Hospital Payments; Mumps Outbreak; Tuberculosis Eradication Plan
Some states are rethinking how to compensate hospitals for services, using Medicare reimbursement rates as a benchmark to control costs for state employee health plans; reported cases of mumps are on the rise at Temple University in Philadelphia; the Lancet Commission outlines a new plan for worldwide tuberculosis eradication.
States Use Medicare Reimbursement Rates as a Benchmark to Redesign How Hospitals Are Compensated for Services
States are making efforts to control the costs of state employee health plans by using Medicare reimbursement rates to redesign how they pay hospitals, reported Kaiser Health News. As an example, Dale Folwell, state treasurer of North Carolina, plans to start paying hospitals Medicare rates plus 82%, which he believes will provide hospitals with a modest profit margin while saving the state an estimated $258 million annually. Traditionally, employers or insurers negotiate behind the scenes with hospitals to request discounts to set prices that continue to rise annually and are usually many times higher than the actual cost. Hospital associations opposing the proposition warn of dire consequences, including that hospital revenues could dramatically fall and cause rural hospitals to close.
Cases of Mumps Rising at Temple University
Health officials in Philadelphia now believe 74 individuals have contracted mumps at Temple University, according to the Associated Press. Laboratory testing has confirmed 15 cases, whereas 59 are considered likely due to reported symptoms. The measles, mumps, and rubella vaccine has been recommended by the CDC to prevent the spread of the infection, but research suggests that its effectiveness fades 10 or more years after a second dose is administered. Mumps is a contagious viral infection that causes swollen glands.
Lancet Commission Unveils Plan to End Tuberculosis
The Lancet Commission on tuberculosis proposed a new set of tactics to eradicate the respiratory disease within a generation, STAT News reported. The plan includes investments in rapid diagnostics, vaccine development, and treatment for high-risk populations. These strategies come with a steep price tag as they are predicted to cost an additional $5 billion per year, which would nearly double current international funding to combat the disease. Tuberculosis is responsible for about 4500 deaths per day and is the most deadly infectious disease.
Prices for care at hospital trauma centers vary across hospitals; drug shortages reached a record high during the first quarter of 2024; although 3 of the biggest makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35, these do not apply to daily inhalers used by the youngest kids with asthma.
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Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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The Biden administration recently launched the Global Health Security Strategy, a new effort to combat the spread of infectious diseases; lawmakers zeroed in on the risks of massive consolidation in health care during the first congressional hearing on the Change Healthcare hack; the FDA recently announced the recall of a pair of heart devices linked to numerous deaths and injuries.
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Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
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