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Health Law's 10 Essential Benefits: A Look At What's At Risk in GOP Overhaul Print E-mail
Written by Michelle Andrews | KHN   
Thursday, 23 February 2017 00:00

khn logo black As Republicans look at ways to replace or repair the health law, many suggest shrinking the list of services insurers are required to offer in individual and small group plans would reduce costs and increase flexibility. That option came to the forefront last week when Seema Verma, who is slated to run the Centers for Medicare & Medicaid Services in the Trump administration, noted at her confirmation hearing that coverage for maternity services should be optional in those health plans.

Maternity coverage is a popular target and one often mentioned by health law critics, but other items also could be watered down or eliminated.

There are some big hurdles, however. The health law requires that insurers who sell policies for individuals and small businesses cover at a minimum 10 "essential health benefits," including hospitalization, prescription drugs and emergency care, in addition to maternity services. The law also requires that the scope of the services offered be equal to those typically provided in employer coverage.

"It has to look like a typical employer plan, and those are still pretty generous," said Timothy Jost, an emeritus professor at Washington and Lee University Law School in Virginia who is an expert on the health law.

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Accountable Care Options, LLC Selected to Particpate in the Next Generation Accountable Care Organization Model for 2017 Print E-mail
Written by Don Silver | BoardroomPR   
Wednesday, 22 February 2017 00:00

Boynton Beach, FL based Accountable Care Options, LLC has been selected to participate in the Centers for Medicare & Medicaid Services’ (CMS’) Next Generation ACO Model starting January 1, 2017.

The federal government is transitioning to alternative payment models from traditional, fee-for-service Medicare payments. CMS is partnering with experienced ACOs deemed ready to assume higher levels of financial risk and reward.

“This is the next stage in a new model of payment for medical care,” said Accountable Care Options CEO Richard Lucibella. “We embrace the model’s challenges and the opportunity to produce greater financial rewards for the physician practices in our organization.”

Accountable Care Options has earned financial rewards for its members since it formed in 2013 and joined the Medicare Shared Savings Program. In its first year, physician Shared Savings payments averaged $500 per fee-for-service Medicare patient in addition to the practice’s regular Medicare reimbursement; physician practices also achieved a quality score of 100 percent from CMS. Accountable Care Options’ Shared Savings totaled $4.4 million in 2014 and $7.2 million in 2015.

Based on its successes, Accountable Care Options applied this year to the Next Generation ACO Model, whose “Better, Smarter, Healthier” approach to improving health care is based on the quality rather than the quantity of patient care provided. The Model tests whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and reduce expenditures for Medicare beneficiaries.

Accountable Care Options currently has 100 primary care providers in 36 offices throughout Palm Beach and Broward counties, serving nearly 12,000 Medicare ACO beneficiaries. Most practices have one or two physicians.

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About Accountable Care Options, LLC: Accountable Care Options, LLC is a privately owned and managed network of South Florida primary care practices providing coordinated care as part of the Medicare Shared Savings Program. The Accountable Care Organization, or ACO, takes all financial risk in the program, while member physicians receive their normal Medicare payments. The network and physicians share in bonuses paid by Medicare for reaching quality care and savings goals. For more information, visit
Billionaire's moonshot is falling far short of the hype Print E-mail
Written by Rebecca Robbins | STAT   
Tuesday, 14 February 2017 14:49

The world's richest doctor had a very bold plan.

He'd assemble an unprecedented collaboration of companies, researchers, and doctors. Their mission: to vanquish cancer. By the year 2020, they'd build a working vaccine and test therapies in 20,000 patients. They would forever transform medicine.

Or so Dr. Patrick Soon-Shiong vowed when he launched his audacious "Cancer MoonShot 2020" a year ago.

The supremely self-confident billionaire behind that vision has drawn attention at the highest levels: He's talked cancer research with Joe Biden, Bill Clinton, even the Pope. He's met with President Donald Trump at least twice since the election. Riding high on his pledge to win the war on cancer, Soon-Shiong is said to have pitched a role for himself as national health care czar in discussions with Trump's team.

But a STAT investigation of Soon-Shiong's cancer moonshot has found very little scientific progress.

Last Updated on Monday, 06 March 2017 16:48
Obamacare sign ups sag under Trump administration Print E-mail
Written by FHI's Week in Review   
Monday, 06 February 2017 19:23

Tami Luhby, in a February 3, 2017 CNN post, reports:

The pace of Obamacare sign-ups slowed in the final days of open enrollment last month, as the Trump administration repeatedly blasted the law and pulled ads reminding procrastinators of the January 31 deadline.

Some 9.2 million consumers selected a plan on the federal exchange,, which handles enrollment for 39 states. That's down from 9.6 million a year ago.

Only 376,000 people signed up in the last two weeks of enrollment, compared to nearly 700,000 who picked plans in the final week a year ago.

Read more in the current issue of Week in Review>>

Last Updated on Monday, 27 February 2017 15:15
Former Tenet Exec Charged in Miami Print E-mail
Written by Jay Weaver | Miami Herald   
Thursday, 02 February 2017 00:00

A former executive with the giant Tenet hospital chain has been charged in Miami with paying bribes to a clinic for patient referrals in a scheme to bill hundreds of millions of dollars to the U.S. government.

John Holland, a former senior vice president for Tenet Healthcare Corp., is also accused of misleading federal authorities about the company’s amends for unlawful billing practices dating back more than a decade.

Holland, 59, pleaded not guilty Wednesday in Miami federal court to charges of paying $12 million in kickbacks to Clinica de la Mama, which referred expectant mothers to the chain’s hospitals for neonatal services reimbursed by the Medicaid program.

The clinic provided prenatal care to predominantly undocumented Hispanic women before referring them to Tenet’s hospitals in Georgia and South Carolina, according to an indictment. The undocumented immigrants were not eligible for regular Medicaid benefits, but they could qualify for certain types of services, such as “emergency” labor and delivery, at taxpayer expense.

Last Updated on Friday, 03 February 2017 18:53
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