Medicaid funding questions swirl after White House orders widespread spending pause (updated)
Jan. 29 update: The White House on Wednesday retracted the OMB memo implementing the general pause of federal grant and loan spending, saying a stringent review of agency spending nonetheless will continue and funding for agencies and programs could still be frozen if deemed to be used in a way that’s contrary to the administration’s…
Proposed MA rate notice for 2026 looks promising for health plans, which soon could reap more gains
The Biden administration’s final action with respect to Medicare Advantage (MA) provided a boost to health plans, which could fare better yet under the Trump administration. For 2026, MA plans would receive a 2.23% increase in their payment benchmarks, according to an advance rate notice posted Jan. 10. That would represent a reversal from 2024…
The pace of hospital rating downgrades slowed in 2024: Five key takeaways
When combining the rating actions of the three rating agencies (Fitch Ratings, Moody’s Ratings and S&P Global Ratings), the number of downgrades (95) declined in 2024 while the number of upgrades (37) increased, compared with 116 and 33, respectively, in 2023. Rating agency downgrades versus upgrades, 2024 Many of the downgrades reflected ongoing expense pressure…
Medicare Part D drug price negotiations are set to include GLP-1s, but questions abound
GLP-1 medications made the second round of drugs that are subject to price negotiations under the Inflation Reduction Act (IRA), according to a CMS announcement during the final days of the Biden administration. However, the future of Medicare’s price negotiation authority is uncertain following the transition of power in Washington, D.C. Congressional Republicans have criticized…
GOP puts ideas for major healthcare spending cuts in writing
Big healthcare provisions and programs face the prospect of cutbacks as congressional Republicans look to pass a budget for the remainder of FY25. With Donald Trump in place for a second presidential term starting Monday afternoon and narrow Republican majorities in both chambers of Congress, the GOP has a chance to influence federal policy on…
UnitedHealth Group leaders reflect on slain colleague, how the industry can improve
In their first investor call since the targeted killing of their colleague spawned intense debate about aspects of the U.S. healthcare system, UnitedHealth Group leaders said a systemwide focus on improvement is needed. CEO Andrew Witty began this week’s Q4 earnings call by paying tribute to Brian Thompson, UnitedHealthcare’s chief executive, who was fatally shot…
Hospital financials projected to continue trending upward despite various X-factors
Hospitals are coming off a year of improved stability that should continue even with looming questions and challenges for 2025, according to recent data and insights. As reported in December, Fitch Ratings upgraded the sector outlook (login required) for not-for-profit (NFP) hospitals to neutral/stable after more than two years in which the outlook was categorized…
Benchmark tool for revenue cycle automation finds some success
A just over one-year-old revenue cycle management benchmarking tool has been working well for two early adopters of the framework, called the Revenue Cycle Management Technology Adoption Model (RCMTAM). The Pennsylvania Mountains Healthcare Alliance (PMHA) and UC San Diego Health (UCSD) have used the model to gain more clarity on how their RCM operations are…
In pushing through restrictions on medical debt reporting, CFPB brushes off criticisms and concerns
Rebuffing apprehensions of healthcare providers and debt collectors, the Consumer Financial Protection Bureau (CFPB) published a final rule to block medical debt from appearing in a consumer’s credit history. As initially proposed in June, the regulations prohibit lenders from obtaining and using information about medical debt when determining a consumer’s credit eligibility (exceptions may include…
Texas Health Resources enhances self-scheduling with flexible options
Amid expected growth in demand from patients to schedule their own clinic visits, an Arlington, Texas-based health system learned that in practice some patients want more than just the ability to go online to choose a visit time, date and provider. Officials for Texas Health Resources (THR) found that out while implementing a new self-scheduling…