Congressional perspectives: PBM reforms

Urban Institute analysis finds 26% of insured adults owe medical debt, with hospitals the largest source

A simple break-even calculation turns a reimbursement advantage into staff minutes, showing practices when prior authorization, denials and uncollected patient balances wipe out a better rate.

Coding scrutiny, payment gaps and a push for price caps show up across Trilliant Health's annual look at where U.S. health care is headed.

Trilliant Health's annual trends report traces primary care shortages, payment gaps and looming price caps to incentives no single stakeholder has reason to fix.

HHS finalizes price transparency updates as employers push insurance vendors to open the books.

EBRI data show employer plans pay hospital outpatient departments about twice what physician offices receive for the same physician-administered drugs, and the commercial market has barely begun to address the gap.

The top news stories in medicine this week.

CMS' proposed cuts to physician fees focus on the operating room. For the primary care physicians managing recovery after surgery, the real gap is much larger.