Indiana law with big implications for hospital pricing may be a bellwether
A landmark hospital pricing bill that recently became law in Indiana could foreshadow similar developments in other states. Indiana hospitals will face both a tax penalty and the loss of their tax-exempt status if their prices exceed designated limits. The limits, to be determined via a formula set by the state’s Office of Management and…
Why pending healthcare policies look so daunting for hospitals
For both revenue and costs, ongoing policy developments pose a risk of aggravating trends that already are constraining hospital budgets. The budget reconciliation bill in Congress and the imposition of extensive tariffs would add to ongoing pressures on hospital finances. Bad debt levels are rising among not-for-profit hospitals, as are supply costs, and those issues…
Why Medicare Advantage provisions could end up in the budget reconciliation bill
This article was updated June 12. According to early discussions in the Senate, a final version of the budget reconciliation bill could reduce the amount of federal spending in Medicare Advantage (MA). The Senate is considering whether to modify the reconciliation bill passed by the House, and one topic of conversation is how to achieve…
Insurers, patients pay less of their bills
Healthcare providers faced growing challenges last year in getting paid for care among patients covered by insurance, according to new benchmark data from Kodiak Solutions. And it was both insurers and patients who were lagging in payment or not paying at all. Denials of coverage by health plans, already a problem in 2023, increased during…
The financial cost of hospital and community violence
A new study assesses the financial impact of violence in hospitals and their communities, finding that the issue amounts to a multibillion-dollar problem annually. Estimated costs total $18.27 billion per year, according to a report published June 2 by the American Hospital Association (AHA). The largest share of that total, $13.1 billion, is the amount…
More details on HHS budget proposals for FY26
An updated version of President Donald Trump’s FY26 budget request to Congress includes new information on how proposed spending cuts would affect HHS and its subsidiary agencies. As described in a summary, the request calls for “radical change” to improve the performance of the U.S. healthcare system, reiterating previously reported ideas for shrinking and restructuring…
Reflections from two advanced platforms for population health management
Hospitals and health systems participating in advanced population health management initiatives generally have certain traits in common. Most likely, they are seeking to redesign how they care for vulnerable populations. They realize that achieving the necessary degree of change is difficult in a fee-for-service scenario because much of what’s needed to offer holistic care is…
CMS announces process change for short-stay inpatient claim reviews in Medicare
Recent CMS directives for hospitals include a process change regarding Medicare patient status reviews. Beginning Sept. 1, Medicare administrative contractors (MACs) will conduct the reviews used to determine the appropriateness of Part A payment for adjudicated short-stay inpatient hospital claims. The reviews to date have been conducted by Beneficiary and Family Centered Care Quality Improvement…
Working to steady the ship: 4 takeaways from the Not-for-Profit Healthcare Investor Conference
As described at a recent conference, hospitals and health systems are retaining a sense of optimism while navigating some of the biggest challenges the industry has seen. Pressures on both revenue and expenses require leaders to try innovative solutions while also continuing to master the nuts and bolts of hospital operations, C-suite executives said May…
New guidance makes hospital price transparency obligations more exacting
Hospitals will have to be more specific in the pricing information they provide under CMS’s updated price transparency instructions. As part of a wide-ranging response to President Donald Trump’s February 2025 executive order on healthcare price transparency, CMS issued new guidance to hospitals and other industry stakeholders within the required 90-day window. Changes to machine-readable…