President-reelect Donald J. Trump has spent the past week announcing his nominees for his administration's cabinet. Last Thursday, he announced he would appoint environmentalist attorney and anti-vaccine activist Robert F. Kennedy, Jr. (RFK) to be...
On Tuesday, President-elect Donald J. Trump announced that he would appoint television personality and Medicare-Advantage-For-All proponent Dr. Mehmet Oz to be the administrator for the Centers for Medicare and Medicaid Services (CMS).
Trump announced that he would nominate the celebrity cardiothoracic surgeon to head up CMS in a...Top of The Day
The Government Accountability Office (GAO) released a report on the market concentration of health insurers across the country from 2020 to 2022. The Hertel Report culled from the report the Arizona leaders for the 2022 individual, small, and large group market. In Arizona BCBSAZ, Centene, UHC & CVS took 2022's top spots.
2022...
This week, Change Healthcare's clearinghouse platform has finally been restored as the outage officially touches nearly a third of all Americans.
Change Healthcare's clearinghouse services for health care related billing and payments were backed up following the February ransomware attack that disrupted prescription transfers, claims...
Like it or not, generative artificial intelligence (AI) is part of healthcare now. Even though the industry has yet to adequately regulate these tools and the usefulness of large language models in the health care space is still unclear, providers and payers alike are using them in the process of administering care.
The Food and Drug...
The transition to value-based care has been ongoing for years. Although advances have certainly been made over the past decade, many have noticed that the switch is taking quite a while. This week, several experts and organizations weigh in on why the transition is slow, and what could speed it up.
Consistently, the leading issues...
Publications from across the healthcare sector considered the impact of expiring enhanced premium tax credits to Americans and insurers as Republicans prepare to control the executive branch and Congress in the new year. Experts predict that ACA Marketplace premiums in Arizona would increase 87% or $780 annually without the expanded...
The independent nonprofit evaluated nearly 3,000 hospitals on their ability to prevent medical errors, accidents and infections. The Hospital Safety Grade uses up to 30 performance measures to assign an “A, “B,” “C,” “D” or “F” to individual hospitals and uses a public, peer-reviewed methodology, calculated by top...
Alison Flynn Gaffney is now CEO of Banner Health's 479-bed Banner – University Medical Center and the 245-bed Banner – University Medical Center South, serving Tucson and surrounding areas. Gaffney takes charge Dec. 2. Midtown Phoenix also gained a new healthcare executive leader as Douglas Ross, MD is now president of Dignity...
OUR NATION IS EXPERIENCING A MATERNAL HEALTH CRISIS
Arizona is Leading the Pack
Data from an Arizona Department of Health Services (AZDHS) report reveals national rates of Maternal Mortality (MM) have steadily increased over the last decade.
Even more alarming, on average 71 people giving birth annually die in Arizona, with...
The Trump campaign made several promises for the future of U.S healthcare policy that the new administration may or may not be able to fulfill. From the personnel appointed to federal regulatory positions, to abortion to Medicaid, experts are weighing in on how to constrain the next president's ability to affect the...
The Centers for Disease Control and Prevention (CDC) published its early release of quarterly estimates from the National Health Interview Survey which found relatively low uninsured rates across the country from 2023 to June 2024.
The report included select estimates of healthcare statistics for the non-institutionalized U.S....
After years of churning in the rumor mill, the Cigna Group has directly stated that it is not pursuing a merger or acquisition with Humana Inc.
The two companies began talks for a potential merger late last year, but the discussion was tabled after they were unable to reassure investors. Earlier this fall, rumors reignited that the...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services announced that it would substantially raise standard monthly premiums for Medicare Part B.
Medicare Part B covers physicians' services, outpatient hospital services, home health services and other medical and health services not covered by Part A. The premium for Part B will...
Nonprofit hospitals pledge to elide financial incentives for a higher commitment to quality of care and community investment in exchange for tax exemption, but giant nonprofit hospitals that generate huge revenue streams are coming under scrutiny.
A recent study showed that 7% of nonprofit hospitals were the beneficiaries of over half...
A Kodiak Solutions data analysis found that Medicare Advantage (MA) plans classify three to four times as many hospital visits as observation stays instead of inpatient stays compared to traditional Medicare. Last year, the Centers for Medicare & Medicaid Services (CMS) finalized a rule clarifying that MA plans need to cover the same...
This month Chief Executive Officer Monica "Mo" Sheldon will step down as the CEO of the Critical Access Hospital (CAH) serving Northern Cochise County and Southern Graham County; she will be replaced by Gary Kartchner, RN, the CEO of Benson Hospital, also a CAH. Both rural hospitals are part of the Tucson-based TMC Health...
It remains a busy enrollment season for the Arizona Marketplace as eight plans, including newcomer Antidote Health, compete for customers shopping for individual and family health insurance coverage. During last year's open enrollment period (OEP) Arizona broke another record with 348,055 people in the state signing up for coverage;...
The National Association of Insurance Commissioners report provides financial and market intelligence on the insurance industry - another tool for insurers to identify their competitors and comparative market share. The Hertel Report collected the top 10 leaders in Arizona including UnitedHealth Group, Blue Cross Blue Shield of Arizona...
A new study looks at the effectiveness of capitated payments for Medicare Advantage plans on reducing incentives for clinicians to provide low-value services.
The study, published in JAMA Network Open, compared data for beneficiaries enrolled in fee-for-service (FFS) Medicare against those enrolled in Medicare Advantage in order to...
After Trumps presidential victory, U.S. regulatory agencies should expect shakeups, future ACA Marketplace enrollees could shoulder more premium costs, Medicare Advantage may see a bump in federal enthusiasm and Medicaid beneficiaries may be subject to work requirements. The three-biggest names in Medicare Advantage saw an immediate bump...
In this week's election, Arizona voters were asked if they wanted abortion to be legal up to the point of fetal viability (23-24 weeks) and they overwhelmingly (62%) said "yes."
Women in Arizona can now expect to access the same level of reproductive healthcare available since the 1973 Roe v Wade decision, which found a women's right...
Last week, the Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Physician Fee Schedule for 2025. It includes a 2.9% cut to physician pay.
The fee schedule includes policies aimed at improving access to primary care and boosting reimbursement for behavioral health, but the pay cut instantly drew harsh criticism...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) published the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Hospital outpatient departments and ASCs will receive a 2.9% raise next year.
The boost includes a 3.4% market basket boost...
Retail pharmacy giant Walgreens Boots Alliance (Walgreens) has agreed to a settlement in a class-action lawsuit that claims the retailer fraudulently overcharged customers for generic drugs paid for by private insurance, Medicare and Medicaid.
The lawsuit was filed in 2017 by a group of individuals and unions who accused Walgreens of...
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