Susan Dentzer: Is consolidation in healthcare the work of modern-day robber barons — or the result of overdue reengineering?
The most successful industrialists of America’s Gilded Age were often skewered by contemporary critics as being robber barons. A new generation of naysayers wants to recycle the old rhetoric, this time targeting organizations focused on healthcare: The critics’ clear message: Big money is helping healthcare get bigger, and it’s a bad deal all around. Many…
Applying AI to revenue cycle management
Three examples of AI applications in healthcare provide insight into how healthcare providers are using the technology today. The organizations are Auburn Community Hospital in Auburn, New York; Banner Health in Phoenix, Arizona; and Community Medical Centers, based in Fresno, California, Addressing RCM staffing shortages: Auburn Community Hospital Auburn Community Hospital, an independent 99-bed rural…
Update: Medicaid DSH payment cut averted as House, Senate pass short-term federal funding
Note: The headline and lead section of this article were updated Oct. 1 with news of a six-week government funding extension that delays the Medicaid DSH cuts and pays for other healthcare programs. The article originally was published Sept. 28 under the headline, “An $8 billion Medicaid DSH cut is closer to happening as a…
How AI is about to change healthcare
For executives who have lived through the marketing of such technological developments as big data, the cloud and the Internet of Things, the prospect of taking on the latest hot concept, AI, might not be appealing. But ignoring AI and all its variations may be a mistake. Although there are different technology solutions being sold…
CMS pressures states to restore Medicaid coverage for some beneficiaries who have been disenrolled
CMS says a recent edict to state Medicaid programs has partially stanched the ongoing wave of disenrollments in the program, with about 500,000 beneficiaries set to regain coverage they had lost and “many” others protected from disenrollment going forward. As described in a Sept. 21 summary, 29 states plus Washington, D.C., have acknowledged a systemic…
HHS sets new administrative fee to be paid by parties in No Surprises Act independent dispute resolution cases
Oct. 6 update: The lead section of this article was updated where noted with news about the arbitration portal. The administrative fee for taking out-of-network payment disputes to arbitration under the No Surprises Act in 2024 would be significantly lower than it was for much of 2023, but triple the current rate, according to proposed…
Solving the nursing crisis: 3 lessons learned from the COVID-19 experience
Accounts of the nursing shortage may vary in emphasis, but the contours of the crisis are plain: The United States does not have enough nurses to deliver the high quality of patient care that all healthcare organizations are mandated to provide. This challenge is driving healthcare facilities to rethink how they staff themselves in the…
As clock ticks toward massive Medicaid disproportionate share hospital cuts, proposed bill would bring relief
A congressional bill that would impose additional transparency requirements on providers also would offer a respite from a sizable cut to a key supplemental payment. A $32 billion reduction to Medicaid disproportionate share hospital (DSH) payments is scheduled to span four years, beginning when federal FY24 gets underway Oct. 1. The Lower Costs, More Transparency…
Legislation to enhance healthcare pricing and billing transparency takes a big step forward in the House
A slew of provisions on healthcare transparency took a step closer to becoming federal law as three House committees last week merged separate bills into a single draft. The resulting bill is just about set for consideration by the full House, where bipartisan support for the major provisions was apparent in the committee phase. The…
OSF plans for value-based care in Medicaid
The majority (70%) of OSF HealthCare’s business is paid for by Medicare and Medicaid, prompting Mike Allen, FHFMA, MBA, the system’s CFO, to identify Medicaid as presenting the next big opportunity for assuming risk under a value-based care approach. “Trying to wade into a value-based agreement for the Medicaid population is not for the faint…