Morning Briefing
Summaries of health policy coverage from major news organizations
Employers Shopping Around For Health Care Coverage Amid Rising Costs
Healthcare Dive: More Employers Considering Medical, Pharmacy Vendor Switch Amid Rising Healthcare Costs, Survey Finds
Changing vendors can be a formidable undertaking for employers, given the costs and efforts associated with switching. But employers are open to much more aggressive action to curb growing healthcare spending, according to the Purchaser Business Group on Health, a nonprofit coalition representing 40 of the largest healthcare purchasers in the U.S. that together spend more than $350 billion each year on coverage for 21 million workers and their families. This year, 37% of the PBGH’s members have issued a “request for proposals” for medical benefits, meaning they’re shopping between insurance providers. The last time the PBGH surveyed its members on this issue, in 2024, just 12% of employers were conducting a medical RFP. (Parduhn, 4/16)
In other health care industry news —
Modern Healthcare: Aetna-Radiology Partners No Surprises Act Lawsuit Dismissed
Aetna’s lawsuit accusing Radiology Partners of gaming the No Surprises Act to win higher reimbursements will not advance, a federal court ruled. The CVS Health subsidiary alleged that Austin, Texas-based Radiology Partners chose not to join insurance networks in order to use No Surprises Act’s independent dispute resolution process, or IDR, to generate payments greater than network rates. Aetna filed its case in the U.S. District Court for the Middle District of Florida in 2024. Radiology Partners denied these claims. (DeSilva, 4/17)
MedPage Today: Physicians Beat AI Scribes On Clinical Note Quality, Study Shows
Clinical notes generated by artificial intelligence (AI) scored lower on quality than those prepared by humans, a cross-sectional evaluation of five simulated primary care cases showed. (Henderson, 4/17)
In Medicare updates —
Modern Healthcare: Medicare Wage Index Lawsuit Escalates Urban Hospital Pay Fight
Urban hospitals claim they were shortchanged by the federal government and the legal fight over Medicare pay is pitting them against their rural peers. Seventy urban hospitals sued the Health and Human Services Department earlier this month, alleging the government owes them millions of dollars after the agency changed how it calculates Medicare payments for hospitals based on local labor costs, which are reflected in the Medicare wage index. The lawsuit stems from longstanding Medicare payment discrepancies between urban and rural hospitals tied to how much hospitals pay staff. (Kacik, 4/17)
Modern Healthcare: What Medicare’s Joint Replacement Model Expansion Means For Providers
The Centers for Medicare and Medicaid Services plans to revive and broaden a Medicare joint replacement bundled payment model that has saved more than $100 million. CMS proposed implementing an expanded version of the decade-old Comprehensive Care for Joint Replacement Model, dubbed CJR-X, beginning Oct. 1, 2027, in a draft regulation published last Friday. (Early, 4/17)
On animal research —
The New York Times: Activists Tear-Gassed At Failed Raid Of Beagle Research Facility
Hundreds of animal rights activists in Wisconsin were thwarted by the police and private security guards as they tried to steal thousands of beagles from a facility that breeds them for sale to research labs and for experiments done on site. Officers and guards fired tear gas and rubber bullets on the estimated 1,000 protesters, witnesses said, to keep them from entering the facility, Ridglan Farms, a state-licensed dog breeder. Ridglan breeds beagles for biomedical research aimed at improving veterinary medicine. The company has denied that it abuses animals. (Benner and Glascock, 4/18)
Stat: A Controversy Over Research Monkeys Highlights Ambiguity Over Health Standards
A leading animal rights group is accusing Pfizer of running afoul of its own standards in the handling of research monkeys, jeopardizing both the welfare of the animals and the integrity of scientific research. But the case also appears to highlight a lack of guidelines for assessing the health of monkeys before they are shipped for medical research. (Silverman, 4/20)
