How nonprofit health systems can benefit from post-acute care partnerships
In recent years, many nonprofit health systems have transferred post-acute care assets to joint ventures (JVs) with for-profit partners, including home health, hospice and inpatient rehabilitation assets. It is incumbent on health system leaders who are pursuing such a strategy to take steps to maximize the benefits, however, which is possible only with an appropriately…
As providers seek resolution of continuing Change Healthcare issues, UnitedHealth Group reports strong financials
The aftermath of the Change Healthcare cyberattack affected the second-quarter financials of parent company UnitedHealth Group (UHG), but not to the point of hindering the company’s continued “diversified and durable growth,” CEO Andrew Witty said during a recent investor call. Q2 revenues increased by 6% year-over-year, while profits dropped by 5.5% amid costs stemming from…
What have we agreed to? Cutting the knot with AI
In ancient Greek legend, the Gordian knot was a knot of extreme complexity that tied an oxcart to a post. Whoever could untie the knot was destined to become the ruler of Asia. By a popular account, when Alexander III of Macedonia (later Alexander the Great) was challenged to untie the knot, he came up…
CMS looks to fortify primary care with proposed new codes for advanced care management
With newly proposed regulations, CMS aims to establish coding and payment for services that promote longitudinal relationships between clinicians and patients in primary care. The provisions, part of Medicare’s 2025 proposed rule for physician payments, incorporate new HCPCS G-codes for advanced primary care management (APCM). Three bundles of APCM services would be billable as codes…
Massive CrowdStrike crash poses big issues for hospital and clinic operations
July 22 updates With scattered exceptions, hospital and health system operations were largely reported as being back to normal Monday. There were few indications that nonurgent appointments needed to be canceled or diverted, although some organizations warned of the possibility of continued delays. On July 20, Microsoft released a recovery tool that it said would…
Medicare’s proposed 2025 rule for physician payments would add to the financial strain facing practices
Medicare’s proposed update to physician payments for 2025 left advocates saying practices will have an increasingly difficult time making ends meet. CMS’s newly proposed rule states that payments are set to be reduced by 2.8% from 2024, based on the change to the conversion factor. The agency explained that it is obligated to implement the…
FTC report levies strong criticism at the business practices of pharmacy benefit managers
Vertical integration by pharmacy benefit managers (PBMs), including with providers, is one reason to be concerned about the excessive reach of PBMs in the healthcare industry, according to an interim staff report issued this month by the Federal Trade Commission (FTC). “Due to decades of mergers and acquisitions, the three largest PBMs now manage nearly…
A proposed Medicare condition of participation would bring a slew of new requirements for OB care
Note: HFMA’s coverage of the payment update in the outpatient payment proposed rule can be found here. Hospitals intending to participate in Medicare must meet new standards for obstetric (OB) care, according to CMS’s proposed outpatient rule for 2025. The rule proposes to establish a new Medicare condition of participation (CoP), whereby hospitals and critical…
Medicare’s proposed outpatient payment update for 2025 doesn’t keep pace with hospital costs, advocates say
Note: Additional coverage of the proposed rule can be found here. Hospital advocates expressed dissatisfaction with the payment update in Medicare’s 2025 proposed rule for hospital outpatient care and ambulatory surgical centers (ASCs). CMS proposes to increase the Medicare rate for outpatient services and ASCs by 2.6%, resulting from a 3% jump in the market…
CMS proposes to hold Medicare ACOs harmless for spending levels stemming from catheter-billing fraud
CMS has issued a proposed rule to mitigate the impact of a high-profile Medicare fraud scheme on accountable care organizations (ACOs). The rule seeks to address “significant, anomalous and highly suspect billing activity for selected intermittent urinary catheters on Medicare Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) claims” as applied to ACOs in the…