The FTC’s new non-compete regulations will affect hospital agreements with physicians, unless courts intervene
Hospital advocates expressed concern about the implications of new federal regulations that prohibit employers from including non-compete clauses in employment agreements. Although tax-exempt hospitals largely fall outside the jurisdiction of the Federal Trade Commission (FTC), which will enforce the regulations, the newly issued final rule stands to affect clinical staffing. Non-compete agreements apply to between…
How a health system goes above and beyond in its price transparency efforts
By maintaining a patient-centric perspective, hospitals and health systems can find opportunities to look beyond regulatory requirements and incorporate top-class price transparency models, according to a recent online discussion. “We want to, first and foremost, empower and equip our customers to make informed decisions about their healthcare services and really shop for the best value,”…
CMS calls for hospitals to be subject to a new bundled payment model and data-reporting requirements
Notable policies in Medicare’s FY25 proposed rule for inpatient hospital care and long-term care hospitals include the formation of a mandatory bundled payment model and requirements for hospital data reporting. Although the proposed payment rate was the headlining aspect of the rule for hospitals, the policy developments could have a longer-term impact on segments of…
The Medicaid unwinding continues to pose issues one year in, but healthcare coverage appears stable
The unwinding of Medicaid continuous-enrollment requirements reached the one-year mark this month amid mixed measures of the effect on overall coverage. In one sense, the impact has exceeded all projections. Since states could begin disenrolling Medicaid beneficiaries on April 1, 2023, coverage for more than 19.6 million beneficiaries had been terminated as of April 4,…
Hospital advocates bemoan the small Medicare payment increase proposed for FY25
The payment increase described in Medicare’s FY25 proposed rule for acute care and long-term care hospitals falls well short of what hospitals need to keep up with costs, advocates say. The payment rate would rise by 2.6% for hospitals that fulfill quality-reporting requirements and meet the criteria to be designated as meaningful users of electronic…
Navigate the new norms in telehealth billing and coding practices
While telehealth has been around for decades, its adoption soared during the COVID-19 pandemic. According to the American Medical Association, telehealth use grew 70% in 2020. While the use of telehealth since then has leveled off, it remains a valuable and popular care option. More than half of patients surveyed said they prefer telehealth for…
Insurers see reasons for concern as CMS keeps the Medicare Advantage purse strings tight for 2025
Medicare Advantage (MA) faces the prospect of constrained revenue and payments for participating stakeholders after CMS finalized what amounts to a small decrease in the 2025 payment rate. Average revenue for MA plans is projected to increase by 3.7%, or more than $16 billion — but that’s primarily because of a prospective increase in the…
How providers can optimize payer contract negotiations
Negotiating payer contracts can be both challenging and frustrating. Payers have significant leverage at the bargaining table, enhanced by payer consolidations and the emergence of dominant local, regional and national plans. But by adopting a transparent data-driven strategy in negotiations with a payer, a provider organization can create an opportunity for building a strong partnership…
Hospital finances are on the upswing, but the toll of the Change Healthcare outage is yet to be seen
Note: The second section of this article was updated where noted with a new comment from Fitch Ratings. There is reason to be optimistic about the state of hospital finances, but the impact of the Change Healthcare cyberattack has added uncertainty to the forecasts. Financial metrics for the first two months of 2024 continued to…
Battle of the Bots: As payers use AI to drive denials higher, providers fight back
Two fighters face each other in the ring, circling together, assuming there will be a single victor. One, representing the U.S. health insurance industry, has made huge investments in aggressive technology over the past several years to automate claim processing and reviews, making it hard for the other fighter — representing the nation’s healthcare providers…