Biden Admin Proposes Changes To Dispute Resolution In No Surprises Act

Stat: Biden Proposes Fixes To No Surprises Act Dispute Resolution Process
The Biden administration dropped a new proposal Friday designed to fix the controversial dispute resolution process that’s part of the federal surprise billing ban. Since the beginning of 2022, the No Surprises Act has shielded patients in most cases against bills from out-of-network providers for care delivered at in-network facilities. But the behind-the-scenes battles between those providers and health insurers over what that care should cost have gotten ugly. (Bannow, 10/27)

In other insurance updates —

Axios: As Millions Lose Medicaid, ACA Sign-Up Season May Help
Relatively few people who lost Medicaid coverage this year have wound up in Affordable Care Act plans — but the HealthCare.gov sign-up period starting this week could be a chance to enroll people who've fallen through the cracks. The ACA's health insurance markets, which offer heavily subsidized coverage for lower-income people, can provide a backstop for some of the millions who have been removed from Medicaid this year as states pare their rolls for the first time since the pandemic. (Goldman, 10/30)

Modern Healthcare: Bright Health, Friday Health Cost ACA Risk-Adjustment Program $1.1B
Health insurance companies will lose $1.1 billion in expected exchange risk-adjustment payments this year because two troubled companies can't make good on their obligations, the Centers for Medicare and Medicaid Services disclosed Friday. Financially struggling Bright Health Group is short $380.2 million owed to exchange carriers ..., CMS wrote in a notice. Bankrupt Friday Health Plans owes $741 million to insurers ... . Bright Health and Friday Health are the sole insurers unable to contribute to the $9.24 billion risk-adjustment program this year. (Tepper, 10/27)

USA Today: Hospitals Terminate Medicare Advantage Contracts Over Payments
One large health system with hospitals in Virginia and Ohio this year cut off in-network access to consumers enrolled in some Anthem Blue Cross Blue Shield Medicare and Medicaid health insurance plans. Two doctors groups with Scripps Health in San Diego are terminating contracts with private Medicare plans over concerns about payments and routine denials. (Alltucker, 10/27)

More health care developments —

The Boston Globe: Cambridge’s Forsyth Institute Joins ADA To Create ‘Biggest Monster In Dentistry’
The American Dental Association is merging with the Forsyth Institute, a quiet, yet influential Cambridge nonprofit credited with some crucial breakthroughs in oral health. ... The program will remain in Cambridge and be led by Wenyuan Shi, president and CEO of Forsyth. “We’re creating the biggest monster in dentistry,” Shi said in an interview. “That really means we’re introducing a lot of innovation into the dental practice.” (Parker, 10/27)

The CT Mirror: Prospect Medical Bought Rockville Hospital. It's Now A Shell Of Itself
Rockville General Hospital has been a fixture in Christen Ellis’ life for decades. She’s been a nurse there for over 30 years. It’s where she gave birth to her kids and where her mother got surgery when pancreatic cancer made it nearly impossible for her to eat. It’s where both her parents eventually entered hospice care during the final days of their lives. (Golvala and Carlesso, 10/29)

Iowa Public Radio: Mercy Iowa City Hospital Bought By UI After Prior Bid Deemed Unviable
In an unusual turn of events, the University of Iowa has won the auction for Mercy Iowa City, reversing an earlier result where Mercy's chief creditor bought the financially imperiled hospital. The UI's original bid of $28 million was resubmitted Friday morning and chosen as the best and highest option. (Smith, 10/27)

Houston Chronicle: Houston's Texas Medical Center Helix Park Bioresearch Campus Opens
The first piece in a long-anticipated multibillion-dollar biomedical research campus opened Thursday in the Texas Medical Center, setting the stage for what could become a game-changing life sciences hub generating $5.4 billion in annual economic impact and tens of thousands jobs in Houston. ... “When you looked at the incredible business and economic platform the state of Texas has, there was one glaring deficiency, and that is to have a massive hub for life sciences,” Gov. Greg Abbott said at the event. (Luck, 10/27)

Modern Healthcare: How Clinically Integrated Networks Could Boost Rural Healthcare
More rural hospitals are joining clinically integrated networks to improve their standing with commercial insurers, maintain services, boost care quality and reduce costs. The Rough Rider High-Value Network, a clinically integrated network of 23 North Dakota rural hospitals, represents the latest of these alliances. Others include the Illinois Critical Access Hospital Network, the Rural Collaborative in Washington state and the Texas Organization of Rural and Community Hospitals. (Kacik, 10/27)

The Atlantic: What Financial Engineering Does To Hospitals
Riverton, Wyoming, a city of about 11,000 people at the feet of the Wind River mountain range, seems far away from the world of Big Finance. Yet like so much of America, Riverton has become well acquainted with the business that most epitomizes today’s Wall Street: private equity. In 2018, the local hospital, SageWest, was purchased by Apollo Global Management as part of the giant private-equity firm’s $5.6 billion deal to buy a chain of hospitals called LifePoint Health. (Nocera and McLean, 10/28)

Also —

The Colorado Sun: Boulder Deconstructs And Recycles An Entire Old Hospital
For three years, the 250,000-square-foot hospital on Balsam Avenue went untouched. Lights, doors, toilets and medical technology sat quietly inside, ready to be bulldozed and sent to landfills. City officials knew they couldn’t leave up the massive beige block of a building. The structure, abandoned when its owner decided to consolidate at a different location, didn’t fit into the walkable neighborhood residents wanted at Balsam and Broadway. In trying to convert the hospital for other use — where occupants could get some sunlight, ideally — they knew they would end up taking most of it down anyway. (Zhang and Booth, 10/29)