On December 20, 2022, the U.S. Congress announced its deal to fund the federal government through 2023, averting an imminent government shutdown. The 4,155-page, $1.7 trillion spending bill spans a vast array of funding initiatives and other bipartisan measures, including a number of noteworthy healthcare provisions. Perhaps most significantly, Congress intervened in the impending cuts to the Medicare Physician Fee Schedule (MPFS), overriding some, but not all, of the payment reductions. This Health Capital Topics article will discuss the congressional measures to ameliorate the payment cuts to physicians in 2023, as well as the other healthcare provisions included in the omnibus spending bill. (Read more...)

On December 6, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed a modernization of the prior authorization process for health insurance. The proposed rule seeks to require certain insurers to implement electronic prior authorization, shorten decision timeframes, and make the process more transparent and efficient. The rule includes “five key provisions and five Requests for Information,” aiming to “improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.” This Health Capital Topics article will review those provisions and requests for information, as well as stakeholder responses to the proposals. (Read more...)

On December 14, 2022, the Centers for Medicare & Medicaid Services (CMS) released a report detailing healthcare spending in the U.S. for 2021, highlighting the decrease in government spending due to reductions in federal spending for COVID-19. Overall, healthcare spending grew 2.7% in 2021 (to $4.3 trillion), much slower than the 10.3% increase in 2020. Healthcare spending as a share of the U.S. gross domestic product (GDP) declined from 19.7% in 2020 to 18.3% in 2021 (although still higher than the 17.6% share in 2019). The overall GDP increased 10.7% in 2021 after having dipped in 2020 – a much faster rate than healthcare spending. This Health Capital Topics article will review the notable findings included in CMS’s report. (Read more...) 

Clinical laboratories (referred to in shorthand as “clinical labs”) are healthcare facilities wherein healthcare professionals such as pathologists and laboratory technologists extract and/or analyze samples of biological specimens collected from patients, typically bodily fluids (e.g., blood, urine, cerebrospinal fluid) and tissues, to help diagnose conditions. Clinical labs are usually located in hospitals, in physician offices, or in an independent setting. (Read more...)