Senate hearing on 340B reflects congressional interest in altering the program
A leading healthcare policymaker in Congress sounds intent on modifying the 340B Drug Pricing Program. Sen. Bill Cassidy (R-La.), chair of the Senate Committee on Health, Education, Labor and Pensions (HELP), led a 340B-focused hearing Oct. 23 during which he called for changes. “If this committee is serious about making healthcare more affordable, about making…
Planning for the One Big Beautiful Bill’s financial impacts on hospitals
In our conversations with hospital and health system leaders, the payment and regulatory implications of the healthcare provisions included in the One Big Beautiful Bill (OBBB) are by far the most recurring and important topic of discussion. More specifically, the leaders we talk to are laser-focused on understanding how the future financial trajectory of their…
Senate committee examines ways to strengthen the supply chain for hospital drugs
Vulnerabilities in the supply chain for pharmaceuticals are putting patients at risk and hampering healthcare providers, according to testimony at a recent Senate hearing. The flaws manifest in shortages of vital drugs and in issues of quality and transparency, experts said during the Oct. 8 hearing of the Senate Special Committee on Aging. In Q1…
OIG report could lead to additional inspection of hospitals’ Provider Relief Fund usage
Some hospitals that received funding support from HHS during the COVID-19 pandemic may need to prepare for additional auditing based on findings of a report by the department’s Office of Inspector General (OIG). The report examined a small sampling of Provider Relief Fund (PRF) recipients and found that 17 of 25 hospitals did not comply…
Cutting through the clutter: Practical strategies to reduce administrative waste in payer-provider interactions
Administrative costs in healthcare continue to rise, often consuming more resources than direct patient care. Nowhere is this more visible, or more solvable, than within revenue cycle management (RCM). These costs are not just a patient care concern; they strain the workforce and directly impact financial sustainability. Much of the challenge stems from a persistent…
AI coding at UMass Memorial tempers staffing shortage
UMass Memorial Medical Center’s radiology department has been able to sidestep a lack of bill coding professionals by adopting AI in the medical center’s coding for radiology. “It’s really hard to get certified coders these days,” said Barbara Scully, associate vice president, physician billing with UMass Memorial, which is located in Worcester, Massachusetts. “It’s one…
No Surprises Act arbitration has been a bonanza for a few provider groups
In a span of 2.5 years through 2024, providers reaped more than $2.2 billion from the No Surprises Act’s arbitration process, relative to the applicable in-network payment rates for the disputed care episodes. The awards received through the NSA’s independent dispute resolution (IDR) process largely arise from “disputes that are primarily initiated and won by…
Hospitals still face a heavy lift getting ready for the TEAM bundled payments model
For the quarter of U.S. hospitals that will participate in the mandatory Transforming Episode Accountability Model (TEAM) starting Jan. 1, 2026, the preparation curve has been steep. In early August, among more than 90 client hospitals of the solutions company Rainfall Health, none was where participants soon need to be, said Eddie Qureshi, founder and…
Government shutdown watch: Various hospital funding sources to be curtailed (updated 11/17/25)
Nov. 17 update: Sizable Medicare payment cut avoided The continuing resolution to fund the government through Jan. 30 has language canceling a looming PAYGO reduction to federal programs, including a 4% cut to Medicare that would have taken effect in 2026. PAYGO is a statutory across-the-board spending reduction to be implemented when legislation increases the…
Hospitals brace for looming federal cuts in Medicaid and elsewhere
The historic healthcare policy changes — and associated Medicaid cuts — in the One Big Beautiful Bill Act have left it to the states to figure out how to keep their residents insured and healthy with $1 trillion less in federal funding. With impacts of the One Big Beautiful Bill Act, or OBBBA, including a…