Healthcare price transparency is heading for a more consequential phase
Key developments loom for healthcare price transparency both legislatively and in the private sector, according to insights from a recent congressional hearing. Sen. Bill Cassidy (R-La.), who is a physician and an influential healthcare policymaker in Congress, conducted a field hearing May 5 with stakeholders in his home state to examine the issue of healthcare…
GLP-1 coverage costs pressure employers and Medicare plans in 2026
Even as evidence accumulates about the efficacy of GLP-1 drugs, concerns surrounding insurance coverage of the products remain unresolved. Both employers and insurers are trying to navigate the dichotomy between clinical benefits and potentially burdensome costs. “Against the backdrop of anticipated double-digit healthcare cost increases, fueled to a large degree by GLP-1s and overall prescription…
Hospital workplace violence escalates financial and workforce pressures
Incidents of violence in U.S. workplaces are disproportionately common in healthcare settings, especially in hospital emergency departments (EDs), and new data helps quantify the toll. It’s long been known that healthcare and social service workers are significantly more likely than workers overall to suffer a workplace violence injury. Bureau of Labor Statistics data suggest the…
States and hospitals prepare for new administrative tasks as Medicaid work requirements loom
Efforts by states to implement the Medicaid work requirement are intensifying, with hospitals likely to play a supporting administrative role when the requirement begins nationwide Jan. 1, 2027, based on findings in a new report. As legislated in the One Big Beautiful Bill Act (OBBBA), adults in the Medicaid expansion population must demonstrate that they…
PAMA laboratory data reporting requirements for hospitals are set to impact Medicare lab payments
Hospitals offering clinical diagnostic laboratory services should take note of imminent reporting obligations that will affect Medicare payment rates. Reporting of commercial final-paid claim rates as the basis for Medicare rate setting was included in the Protecting Access to Medicare Act of 2014 (PAMA) and initially took place in 2017. Subsequent phases of data reporting…
Site-neutral payment debate intensifies in hospital affordability hearing
Site-neutral payment is at the forefront of the debate on policy levers to enhance affordability in the hospital industry, as indicated during a congressional hearing Tuesday. The House Ways and Means Committee hosted a panel of hospital CEOs, seeking insights on ways to tamp down spending on hospital care. Prices in the sector have risen…
ACA marketplace constraints reduce hospital revenue, shift payer mix
Coverage changes in government healthcare programs are starting to show up in hospital financials, based on Q1 reporting from the for-profit hospital sector. Most notably, 2026 cutbacks in Affordable Care Act (ACA) marketplace coverage are manifesting in lower revenues, while hospitals are getting a taste of what’s to come next year in Medicaid coverage. In…
CMS proposes electronic prior authorization for drugs
May 11 update Developments since publication of this article include CMS’s announcement that implementation of electronic prior authorization would be added to the pledges taken by participants in the Health Tech Ecosystem. The ecosystem is a public-private partnership launched in 2025 to establish a nationwide digital healthcare infrastructure that improves data interoperability and empowers patients…
Hospital margins decline in 2026 as expenses outpace revenue
As hospitals seek to shore up their finances in a challenging environment, cost-focused initiatives are taking priority. “Organizations are saying, ‘We’ve got the revenue picture, [now] we’ve really got to get our expense picture to be sustainable with our revenue picture,’” said Steve Wasson, chief data and intelligence officer with Strata Decision Technology. “And what…
Out-of-network pricing lawsuits test MultiPlan, Zelis business models
April 27 update Zelis provided a statement to HFMA regarding the lawsuit against the company’s out-of-network pricing model (see the original story below). “Last month’s decision was procedural and does not change Zelis’s position,” a company spokesperson said. “Zelis operates with a strong commitment to integrity, transparency and full compliance with all applicable laws and…