Stay in the know with Becker's Hospital Review's weekly roundup of the nation's biggest healthcare news. Here's what you need to know this week.
1. CMS proposes changes to Physician Fee Schedule: 15 things to know
CMS released a proposed rule that would update the Medicare Physician Fee Schedule for calendar year 2016. This year, CMS is proposing a number of new policies, including several that are a result of recently enacted legislation. Medicare uses the PFS to reimburse providers for covered physicians' services provided to Medicare Part B beneficiaries. The PFS assigns relative values to more than 7,400 services meant to account for the amount of work, malpractice expenses, and direct and indirect practice expenses associated with providing the service. The relative value components are also multiplied by a geographic adjustment factor to account for cost variations across localities.
2. Aetna inks $37B deal to acquire Humana: 5 things to know
Hartford, Conn.-based health insurer Aetna entered into a definitive agreement to acquire all outstanding shares of Louisville, Ky.-based Humana in a deal valued at $37 billion. Under the deal, Humana stockholders will receive $125 in cash and 0.8375 Aetna common shares for each Humana share. Aetna Chairman and CEO Mark Bertolini will serve as chairman and CEO of the combined company, which will have more than 33 million medical members, based on memberships as of March 31. The transaction is expected to close in the second half of 2016.
3. Cigna files multimillion-dollar suit against 11 ASCs for OON fee-forgiveness model: 5 things to know
Cigna Health and Life Insurance Co. filed a billing fraud suit in federal court attempting to recoup millions paid to 11 Indiana-based surgical centers allegedly participating in a "fee forgiveness" model to attract Cigna's out-of-network patients, according to a Law 360 report. Cigna claims the surgery centers attracted out-of-network members by reducing the members' copays and other fees but charging Cigna inflated prices to recoup losses. Cigna allegedly paid the 11 surgery centers more than $6.5 million in claims before realizing the centers were allegedly using the "fee-forgiving" model for out-of-network patients. The insurance company stopped paying those ASCs and now requests the money returned and an injunction against attempts at similar "fee-forgiving" models in the future.
4. Equity Group Investments to take majority ownership in Ardent's hospital operations
Ventas — a real estate investment trust — reached a deal with Equity Group Investments, giving EQI a majority ownership of the hospital operations of Nashville, Tenn.-based Ardent Health Services, which Ventas agreed to buy earlier this year. Under the agreement, Ventas will own a 9.9 percent interest and EQI will own a majority interest. Full terms of the transaction were not provided on Tuesday. Ventas first announced a deal between the parties in April, when the company said it planned to pay nearly $1.8 billion for the hospital chain.
5. US records first measles death since 2003
A woman in Washington state died from the measles, meaning the United States has recorded its first measles death since 2003, according to the Washington State Department of Health. Her measles went undetected — she didn't show common symptoms of measles, like a rash — until an autopsy confirmed she had the virus. Her cause of death was pneumonia due to measles. The Washington health department believes the woman likely contracted the virus at a local medical facility during an outbreak in Clallam County, which is just south of the Canadian border of British Columbia.
6. CMS announces changes to ICD-10 to help ease transition: 4 points to know
CMS released additional guidance for ICD-10 that will allow for greater flexibility in claims auditing and quality reporting to help providers transition to the new coding and billing sets. Providers will have a one-year transition period. During the first year of ICD-10, providers' Medicare claims will not be denied or audited solely based on the specificity of diagnoses codes as long as they still come from the appropriate family of ICD-10 codes. Similarly, physicians will not face penalties for the Physician Quality Reporting System based on the specificity of diagnoses codes as long as the code is from the correct ICD-10 family of codes.
7. Cerner wins Military Health System contract
The Defense Health Agency awarded Cerner a contract to replace the Military Health System's anatomic pathology laboratory information system. All Department of Defense military treatment facility anatomic pathology laboratories worldwide will deploy Cerner's CoPathPlus software, which offers anatomic pathology workflow automation, management reporting and quality-assurance functionality. Cerner will issue software licenses and implement server hardware, peripheral equipment and services.
8. Out-of-pocket healthcare costs rose modestly under PPACA last year
A new study by the Robert Johnson Wood Foundation found that out-of-pocket healthcare costs rose moderately under the Patient Protection and Affordable Care Act last year, according to The Hill. The study, which included data from 15,000 physicians, revealed that the amount of money a patient spent per visit increased by 3.5 percent over the past year, totaling about $1 per visit, including copayments and deductibles.