Should Insurers Be Able To Deny Emergency Room Claims? Companies Test It Out And Hospitals Are Livid
To cut high health care costs, insurers are slowly starting to look at an area that's always been off-limits before: emergency room visits. But it's not going over well with hospitals, doctors or lawmakers.
Politico:
Insurers Spark Blowback By Reducing Emergency Room Coverage
Health plans intent on driving down costs are zeroing in on emergency room visits — one of the biggest drivers of medical inflation but a category of care that's seldom been subject to denials. Anthem, the country’s largest Blue Cross Blue Shield plan, shook the market last year by refusing to pay for some ER visits it deemed unnecessary, triggering heated battles with hospitals and doctors and fueling a broader debate over whether patients can find less expensive settings without putting their health at risk. (Rayasam and Demko, 6/12)
In other news on hospitals —
Modern Healthcare:
Hospital Star-Ratings Release Delayed By CMS
The CMS will not update the hospital quality star ratings on Hospital Compare next month as it continues to evaluate concerns from stakeholders on methodology changes, the agency told hospitals on Tuesday. The agency had posted proposed changes to the methodology in late May for hospitals to preview before the July release. Now, the CMS said it needed additional time to analyze "the impact of changes to some of the measures on the star ratings and to address stakeholder concerns." (Castellucci, 6/12)
The Star Tribune:
Minnesota's Hospital Germ Fighters Report Making Progress
Hospitals are reporting progress in their fight against infection-causing germs — from fungus in the bedsheets to bacteria on whiteboard markers — and against one another in their competitive race to avoid federal penalties for infecting their patients. They gained motivation to clean up their acts in 2014, when the U.S. Centers for Medicare and Medicaid Services started tracking rates of hospital-acquired conditions and financially penalizing those with the worst rates. (Olson, 6/12)
