In his final State of the Union address Tuesday night, President Obama launched a national campaign to eliminate cancer, the leading cause of death worldwide.
Transparency may be the buzzword of the year in healthcare, but it can be notoriously difficult to achieve. The federal government has made numerous efforts, including the launch of the Open Payments database so the public can find out about payments to physicians from drug and device companies, and the Hospital Compare and Physician Compare databases for researching providers.
Kindred Healthcare Inc. agreed to pay $125 million to settle federal allegations it provided unnecessary therapy services to nursing-home patients as part of a scheme to overbill the federal Medicare program, according to the agreement finalized on Tuesday. Several nursing homes that hired Kindred's therapy unit, RehabCare, to provide services to their residents separately agreed to pay the federal government about $8 million for their role in the alleged scheme. Kindred said it agreed to the settlement to avoid costly and distracting litigation, but denied wrongdoing. A Kindred spokesman didn't respond to a request for comment Tuesday. [Subscription Required]
Implementing Health Reform. On January 11, 2016 Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt gave a major policy address at the J.P. Morgan Healthcare Conference about the future of the Affordable Care Act (ACA) marketplaces. His speech was clearly intended to address concerns that insurers have been expressing about the viability of the health insurance marketplaces, including allegations that consumers have been gaming special enrollment periods (SEPs) to enroll in coverage once they become ill and then cancel coverage when they regain health. Slavitt asserted that although the marketplaces are still young, they are maturing and moving onward from their startup phase.
Health insurer Anthem Inc. offered 2016 earnings guidance roughly in line with analyst expectations and said it enrolled more members than it expected last year. Shares in the company rose 4.6% in morning trading, paring the stock's loss over the past three months to 6.6%. The Indianapolis-based company said in a securities filing Tuesday that it expects to post "at least" $10.80 in adjusted per-share profit, up from an anticipated $10.16 for 2015. Analysts surveyed by Thomson Reuters have projected $10.85 in adjusted earnings per share this year. The forecast doesn't include costs stemming from its proposed $48 billion acquisition of rival Cigna Corp. , Anthem said. [Subscription Required]
A looming 2016 ballot initiative threatens to upend the foundations of hospital finance in Massachusetts, even if the measure never reaches the voters. The clash involves a fractured hospital community, insurers, a labor union, and state government in a controversy more than 25 years in the making. For decades, savvy Massachusetts policy entrepreneurs have learned to use the threat of a statewide ballot initiative to compel legislative change that would never have happened absent the ultimatum. I saw this up close in 1994 when Common Cause forced major campaign finance reform through a Legislature eager to avoid the group's more punishing ballot proposal.