June 11, 2024
Providers | Tea Leaves
  • The U.S. Supreme Court has agreed to review a case challenging how the Department of Health and Human Services (HHS) applies Congress’ formula for calculating disproportionate share hospital (DSH) payments. The suit, Advocate Christ Medical Center v. Becerra, was originally filed in 2017 by a group of more than 200 hospitals over the agency’s formula used to calculate outlays. They argued the method did not fully account for care provided to patients eligible for Supplemental Security Income (SSI) patients. HHS makes DSH payments to hospitals that serve a high number of low-income patients. The payments are calculated based on two factors: the hospital’s Medicare patients with low incomes and those with low incomes but not on Medicare. (Articles here and here)
  • The pharmacy industry is undergoing a significant shift as major chains like CVS Health, Walgreens, and Rite Aid close hundreds of stores due to challenges like declining prescription reimbursement and changing consumer behavior. This consolidation leaves behind communities, particularly in urban and rural areas, where pharmacies have been trusted sources of care. Disparities in access to pharmacies are evident, with predominantly Black and Latino neighborhoods having fewer per capita. States like Alaska, Oregon, and New Mexico have the fewest retail pharmacies per capita, with most being chain-owned. Despite closures, pharmacies are increasingly vital health care providers, offering clinics and counseling services, particularly in rural areas where they play central roles in community health. (Article here)
  • Major retailers are reconsidering their health care ventures, scaling back ambitious plans but staying in the market. Despite aiming for a share of the $4.5 trillion health care industry, economic challenges like low reimbursement and high costs have led to setbacks, with closures and losses for giants like Walgreens and Walmart. Instead, retailers are shifting focus to services consumers pay for out of pocket, like vision clinics and cash-pay services. Expect more partnerships and strategic shifts as they navigate this landscape, particularly with Amazon’s expanding health care ventures. Retailers are pausing to reassess their strategies in the health care market. (Article here)