CMS Floats Overhaul Of Medicare Advantage Star Ratings System
CMS may nix a dozen Medicare Advantage and Part D measures that focus on operational performance or completion of administrative processes. Other health industry news is on Humana's plan to appeal a court loss over the Medicare Advantage star ratings, Asheville's Mission Hospital is removed from immediate jeopardy by CMS, and more.
Modern Healthcare:
Medicare Advantage Star Ratings To Be Revamped In CMS Proposal
Federal regulators are proposing paring back the Medicare Advantage Star Ratings program. The draft regulation issued Tuesday by the Centers for Medicare and Medicaid Services also invites public input on how the administration should overhaul risk adjustment and other Medicare Advantage-related policies. It additionally includes tweaks to the Medicare Part D prescription drug program. The proposed rule could offer insurers a bit of breathing room amid increasing pressure on prior authorization, marketing and audits. (Early, 11/25)
Fierce Healthcare:
Humana To Appeal Loss In MA Star Ratings Lawsuit
Humana will appeal a court loss over the Medicare Advantage star ratings, according to a filing issued Tuesday. The insurer filed a notice that it will appeal the District Court ruling to the Fifth Circuit Court of Appeals. The filing doesn't offer further details on the grounds to appeal. (Minemyer, 11/25)
More health industry news —
Newsweek:
CMS Removed Mission Hospital From Immediate Jeopardy
Mission Hospital in Asheville, North Carolina, has been removed from immediate jeopardy by the Centers for Medicare and Medicaid Services (CMS), according to the health system. This was the third time Mission Hospital was placed under immediate jeopardy since it was bought by HCA Healthcare in 2019. Back in October, the North Carolina Department of Health and Human Services (NCDHHS) recommended Mission Hospital be put in immediate jeopardy for practices that resulted in an unsafe environment for patients after conducting an investigation. (Giella, 11/25)
Modern Healthcare:
Encompass, Vanderbilt Health Partner On Inpatient Rehab Hospital
Vanderbilt Health and Encompass Health announced plans to build a 40-bed inpatient rehabilitation hospital near Nashville, Tennessee. The facility, set to open in 2028, will be the second joint venture between the two organizations.A spokesperson for Vanderbilt Health could not provide financial details about the joint venture. Encompass Health did not respond to requests for comment. (Eastabrook, 11/25)
St. Louis Post-Dispatch:
BJC Health System, Aetna Remain At Odds In Coverage Talks
BJC Health and health insurer Aetna have yet to reach coverage agreements for the upcoming year, leaving St. Louis-area patients in limbo. Without a new agreement, BJC Health will be out of Aetna's coverage network employer-sponsored commercial plans, starting Jan. 1. (Suntrup, 11/25)
The Boston Globe:
Dana-Farber Cancer Institute To Receive $20 Million Grant From Facebook Cofounder’s Foundation
Dana-Farber Cancer Institute has been awarded $20 million from a foundation started by Facebook cofounder Eduardo Saverin and his wife, Elaine. The funding from the Elaine and Eduardo Saverin Foundation will be used to advance metastatic breast cancer research and care, according to an announcement posted on Dana-Farber’s website. (Sweeney, 11/25)
The Baltimore Sun:
Kennedy Krieger Nets Anonymous $5.5 Million Gift For Pediatric Cancer
Two researchers at the Kennedy Krieger Institute will share a $5.5 million anonymous gift, which will support their research efforts to improve the brain health of children with brain tumors. (Hille, 11/25)
Modern Healthcare:
Aetna, Cigna ‘Downcoding’ Highlights AI, Private Equity’s Impact
The office secretary had some bad news for Dr. Leonard Klay: His OB-GYN practice was broke. It wasn’t entirely a surprise, Klay said. The physician had already noticed some claims sent to insurers for reimbursement had been “downcoded,” resulting in smaller payments. Anxious about his predicament, he alerted the California Medical Association, which assured him he wasn’t the first to sound the alarm. But Klay had to face reality, he said. (Tong, 11/25)
