APMA News Brief

Many healthcare stakeholders want more muscle from state insurance commissioners' efforts to help states police how health plans assemble and manage their provider networks.

Visit http://www.modernhealthcare.com/article/20141120/NEWS/311209971/providers-advocates-seek-tougher-rules-on-network-adequacy to view the full article online.

It's open enrollment time, not only for people selecting health insurance plans through their employers or on their own, but for people enrolling in plans using the online marketplace under the federal Affordable Care Act (ACA). People can use the marketplace on their own or with an in-person counselor. Click here to continue reading.

Editor's note: Visit APMA's healthcare reform page for more resources and information on how the ACA affects the profession.

Federal health officials are moving to stop some employers from cutting hospital coverage in the health insurance they provide under Obamacare.

Visit http://thehill.com/policy/healthcare/225195-hhs-moves-to-stop-employers-from-forgoing-hospital-coverage to view the full article online.

The Medicare Advantage star ratings program is already risk-adjusted for clinical factors such as comorbidities. Now federal officials are considering adjusting the quality rating program based on beneficiary income levels.

Visit http://www.healthleadersmedia.com/content/HEP-310617/CMS-Mulls-IncomeAdjusting-MA-Stars to view the full article online.

Overcoming the infrastructure challenges of harnessing big data in the healthcare environment will be critical for better population health management. Click here to continue reading.

Editor’s note: Don’t miss APMA’s Health IT resources on APMA.org.

The ability of employers to slash their early retiree health care costs will depend on the outcome of an upcoming U.S. Supreme Court decision on whether federal premium subsidies authorized by the health care reform law can be used by retirees to purchase coverage in federal health insurance exchanges.

Visit http://www.businessinsurance.com/article/20141123/NEWS03/311239982?tags=|62|307|74|278 to view the full article online.

According to the Centers for Disease Control and Prevention, 21.9 million people in the United States are diagnosed diabetics — with an additional 8.1 million people who have diabetes but haven't been diagnosed.

Visit http://www.newsday.com/news/health/common-myths-about-diabetes-1.9569087 to view the full article online.

If you plan properly and eat in moderation, your diabetes won't get in the way of you savoring a delicious Thanksgiving meal.

Visit http://health.usnews.com/health-news/patient-advice/articles/2014/11/21/how-to-navigate-thanksgiving-with-diabetes to view the full article online.

By the year 2020, it is expected that one in four people will be diabetic. To stop the rise in numbers, prevention is key, and that is the main objective behind this diabetes awareness month. Click here to continue reading.

Editor’s note: See APMA’s "YOU Can Outsmart Diabetes" campaign materials at APMA.org.

Diabetics are highly prone to foot and leg ulcers or wounds. One factor: They lack proper circulation and oxygen to their legs and the arteries leading to their feet tend to harden over time. Another factor is that diabetics frequently develop neuropathy, or a lack of feeling in their feet. As a result, they may develop sores due to tight shoes or normal strain and not feel them.

Visit http://www.miamiherald.com/living/health-fitness/article4061080.html to view the full article online.

Diabetes is an expensive disease to treat, costing the United States $244 billion in 2012, according to an analysis of the disease's economic burden.

Visit http://www.npr.org/blogs/health/2014/11/20/365279289/what-diabetes-costs-you-even-if-you-dont-have-the-disease to view the full article online.

As the Affordable Care Act hosts its second-ever open enrollment, doctors are increasingly vocal about the bill’s benefits for patients.

Visit http://www.healthline.com/health-news/doctors-speak-out-in-favor-of-health-reform-112414 to view the full article online.

Consortium members, including Blue Cross Blue Shield of Michigan, Humana, and other payers plan to meet with provider specialty groups to help them translate the ICD-9 codes they use most into the ICD-10 codes. Click here to continue reading.

Editor’s note: APMA’s ICD-10 Resources will help you prepare for the transition to happen Oct. 1, 2015.

One analyst expects about 11 million people to enroll in individual health plans, based on his firm’s survey of clients in October.

Visit http://www.healthcarefinancenews.com/news/wall-street-analysts-expect-big-2015-enrollment-affordable-care-act to view the full article online.

The final OPPS fee schedule increase factor is 2.2 percent, while the ASC PPS update is 1.4 percent.

Visit http://www.healthcarefinancenews.com/blog/understanding-2015-medicare-hospital-outpatient-payment-rates to view the full article online.

The Obama administration took another step to close what many see as a health-law loophole that allows large employers to offer medical plans without hospital coverage and bars their workers from subsidies to buy their own insurance.

Visit http://www.webmd.com/health-insurance/20141124/hhs-formally-moves-to-close-loophole-allowing-plans-without-hospital-benefits to view the full article online.

Small business owners, who were given a reprieve and are being allowed to renew health insurance plans for 2015 even if they aren't compliant with ACA, are bracing to be socked with substantial premium hikes in 2016.

Visit http://www.pantagraph.com/news/local/small-business-owners-brace-for-rate-shock/article_39a2e8d5-f88c-5bc7-a4e3-e7c5058dafeb.html to view the full article online.

Big-data technology will eventually underpin the healthcare system, though to what extent and what that means to patients are questions needing to be asked.

Visit http://www.techrepublic.com/article/big-data-will-enhance-healthcare-but-to-whose-benefit/ to view the full article online.

Despite recent reports that indicate ICD-10 may not break the bank in quite so dramatic a fashion as the AMA once predicted, the new code set still presents a number of challenges to financially vulnerable healthcare organizations.

Visit http://ehrintelligence.com/2014/11/24/will-revenue-cycle-outsourcing-save-healthcare-icd-10/ to view the full article online.

Just when open enrollment for 2015 under the Affordable Care Act (ACA) appeared to be going well after the disaster of a year ago, officials with HHS were forced to admit last week that enrollment numbers were inflated due to a calculation error, by including freestanding dental plans with medical plans.

Visit http://www.ajmc.com/focus-of-the-week/1114/Another-Unforced-Error-Rattles-ACA-Year-2-Open-Enrollment to view the full article online.

The federal government shelled out billions of dollars to get health insurance marketplaces going in the 14 states that opted to run their own. Now they must act like true marketplaces and start paying for themselves.

Visit http://www.usnews.com/news/politics/articles/2014/11/23/health-exchanges-finances-face-test-in-2nd-year to view the full article online.

A new focus on transparency, accountability and the availability of information is created by a new CMS proposed rule.

Visit http://revcycleintelligence.com/2014/11/24/cms-proposed-rule-improve-payment-parameters-2016/ to view the full article online.