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
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. The sprawling legislation gave Medicare authority to negotiate prices for selected drugs. The first group of 10 Part D…
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…
Report: Payer requests for information are slowing reimbursement
Payers are increasingly rejecting claims through requests for information (RFI) that in total serve no purpose other than to delay reimbursement, according to “Death by a thousand requests,” a report from consulting firm Kodiak Solutions. RFI claim denial rates as a percentage of total billed charges climbed to 3.82% in 2024 through May, up from…
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…
Ascension’s investment in R1 RCM pays off with $1.1 billion valuation
R1 RCM signed a definitive agreement to be acquired in full by funds affiliated with investment firms TowerBrook Capital Partners — currently a partial owner — and Clayton, Dubilier & Rice for $8.9 billion including about $3 billion in debt. The deal values the revenue cycle management company at $14.30 per share, which would attach…
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,…
HFMA recognizes top 9 articles published in hfm, 3 awarded for editorial excellence
HFMA is recognizing the top nine articles published in hfm during FY23-24, with three selected as the winners of the Helen Yerger/L. Vann Seawell Best Article Award for outstanding editorial achievement. Also lauded are the top three runners-up and top three staff-written articles. Myriad topics from increasing adoption and refinement of payer scorecards to using data…