Annual Conference Day 1: HFMA’s Ann Jordan announces new tool to quantify the performance of the healthcare industry
HFMA is formally taking the lead in providing the healthcare industry with true measurements of the system’s capacity to meet present and future demand, President and CEO Ann Jordan announced Sunday. While kicking off HFMA’s 2025 Annual Conference in Denver, Jordan described the launch of the U.S. Healthcare Vitals Tracker, which “creates a common starting…
CMS finalizes the program integrity rule for the Affordable Care Act insurance marketplaces
CMS formally implemented an Affordable Care Act marketplace rule that is expected to reduce plan enrollment in the name of program integrity, but the agency took steps to try to mitigate the long-term impact. Unlike in the earlier proposed rule, the final rule allows some of the new restrictions on enrollment to sunset after 2026.…
Part A hospital spending is helping to accelerate Medicare insolvency, trustees say
The costs of hospital inpatient care are a key driver in forecasts that the Medicare Hospital Insurance (HI) Trust Fund will run out of money within eight years. As described in the latest annual report of the Medicare trustees, the projection of a 2033 insolvency date represents a three-year acceleration from last year’s estimate. Changes…
Health systems say the budget reconciliation bill is bad news for patients and hospitals
Even before a Senate committee produced legislative text that would increase the Medicaid cuts in the budget reconciliation bill, hospitals were preparing to amplify their opposition to the bill. The changes wrought by the Senate are likely to make the matter more urgent for hospitals that could be exposed to potentially significant revenue declines. After…
Modernizing UM: A case for system-level change
For many health systems, utilization management (UM) has long been a functional necessity, but rarely a strategic priority. Originally designed to ensure clinical appropriateness and support payer requirements, UM often grew up within hospital walls, shaped by local workflows and embedded within broader care management structures. As a result, traditional UM functions today are frequently…
Senate version of the budget reconciliation bill does not look promising for providers
Note: The lead section of this article was updated June 17 with clarifying information on state-directed payments. As released late Monday afternoon, the Senate Finance Committee’s healthcare proposals that would be part of the budget reconciliation bill go beyond the House bill in constraining Medicaid spending. Key changes from the version passed by the House…
New taxes to hit hospitals as a result of the budget reconciliation bill (updated)
This article has been updated July 8 as noted to reflect changes made to the bill between the version passed by the House and the final legislation. As congressional Republicans continue their discussions on the budget reconciliation bill, not-for-profit (NFP) hospital leaders should be aware of items that have gotten less attention than the retrenchment…
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…