Nick Hut
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Nick Hut
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Hospitals see a margin advantage as care migrates to the outpatient department
The site-of-care shift toward the outpatient setting increasingly is manifesting in margin per case, according to recent financial data. “While overall margins for both inpatient and outpatient hip and knee replacement surgeries have declined, outpatient procedures now have higher margins than inpatient procedures,” Strata Decision Technology wrote in its Performance Trends Report for Q2 (registration…
CMS announces negotiated Medicare Part D drug prices, looks to blunt a potential spike in premiums (updated)
Note: This article was updated Oct. 2 with news about 2025 projected Part D premiums. See the update below. CMS announced the first set of negotiated drug prices under the Inflation Reduction Act (IRA) and recently moved to head off a significant premium increase that’s projected to arise due to provisions in the 2022 law.…
Hospital revenue is enhanced by state-directed Medicaid payments, health systems report
State-directed supplemental payments made through Medicaid are a growing source of hospital revenue, according to financial reporting from the for-profit hospital sector. In reporting their Q2 financials, several of the nation’s largest health systems cited Medicaid supplemental payments as a boost. State-directed payments are a relatively new form of those payments, applying to Medicaid managed…
The courts continue to favor providers in No Surprises Act litigation, this time at the appellate level
After a string of victories in federal district court, a medical association’s success at contesting aspects of the No Surprises Act’s arbitration process recently continued at the appellate level. In an Aug. 2 ruling, the U.S. Court of Appeals for the Fifth Circuit upheld a lower court’s finding that regulations issued in 2022 gave too…
Mandatory Medicare bundled payments and respiratory disease reporting are on the way for hospitals
Hospitals in nearly a quarter of U.S. markets soon will be required to participate in a Medicare bundled payment model covering five surgical procedures, CMS said in newly released regulations. The model is among several policies of note in Medicare’s FY25 final rule for hospital inpatient care and long-term care hospitals. See this previous article…
Hospitals will get only a small bump in Medicare inpatient payments for FY25
Hospital representatives were less than excited about the rate update in Medicare’s FY25 final rule for inpatient care and long-term care hospitals. Published Aug. 1, the rule includes a 2.9% rate increase for acute care hospitals in the fiscal year that begins Oct. 1. The increase is derived from a 3.4% hike in the market…
The fate of the FTC’s ‘noncompete’ rule appears muddled after early court decisions (updated)
Aug. 20 update: This article has been updated with news that a court has halted the FTC’s rule from taking effect. See the update below. A highly scrutinized rule prohibiting employers from using noncompete agreements has received a mixed reaction in the courts during the leadup to its implementation. Set to take effect Sept. 4,…
Ramifications of a proposed rule to halt credit reporting of medical debt
A proposed rule from the Consumer Financial Protection Bureau (CFPB) would curtail the inclusion of medical debt in credit evaluations, potentially shaking up healthcare billing and collections processes. The CFPB framed part of its rationale for the June 11 rule in the context of privacy, noting Congress previously limited the sharing of a patient’s medical…
News Briefs: Supreme Court ruling on Chevron makes regulations more vulnerable to legal challenges
The Supreme Court issued a decision June 28 that has dramatic implications for the regulatory infrastructure in healthcare, among many other industries. Under the Supreme Court’s 1984 Chevron v. Natural Resources Defense Council decision, courts were guided to give deference in their rulings to federal regulatory authorities such as CMS. Such agencies were deemed to…
Appeals court eliminates Medicare supplemental payments for low-wage hospitals (updated-2)
Note: This article was updated most recently Oct. 4 with news that CMS has ended the low-wage-index policy. See that update below. Plaintiff hospitals won litigation last week at the federal appellate level that will adversely affect Medicare payment for some rural hospitals. The U.S. Court of Appeals for the D.C. Circuit backed a district…