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…
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…
Hospital financial metrics remain steady even as costs rise and reimbursement challenges await
The latest data on financials for the not-for-profit (NFP) hospital sector hints at the challenges in store. While margins have not taken a significant hit for health systems, other metrics reflect rising costs, according to the latest monthly report from Strata Decision Technology. Beyond that immediate concern is the prospect of reduced reimbursement not only…
Proposed 340B rebate model generates an array of concerns among providers
Hospital advocates are pushing back on a fast-approaching rebate model for the 340B Drug Pricing Program, while a new Congressional Budget Office (CBO) report illustrates the accelerating spending in the program. The Health Resources and Services Administration (HRSA), which administers 340B, previously announced that a pilot program to test the application of a rebate model…
The hospital tax exemption comes under scrutiny in Congress
At a time when concerns over reimbursement and costs already are intensifying, Congress recently held a hearing to discuss policy changes that could exert further pressure on the not-for-profit (NFP) hospital sector. A subcommittee of the House Ways and Means Committee met Sept. 16 to examine the NFP hospital tax exemption, soliciting proposals that could…
CMS describes how $50 billion will be distributed for rural healthcare
The Trump administration announced the application period for the Rural Health Transformation Program, giving states an opportunity to claim a piece of a $10 billion FY26 allotment on behalf of their hospitals and clinics. Created by the budget reconciliation bill known as the One Big Beautiful Bill Act, the fund is set to disburse up…
A large health system says revenue could fall by at least $50 million if the ACA subsidies expire
With time running short to maintain enhanced subsidies for the Affordable Care Act (ACA) insurance marketplaces, health system leaders are trying to gauge the consequences of a potential mass disenrollment. Universal Health Services (UHS), a for-profit system that operates more than 400 care sites, is one of the few healthcare organizations to have publicly released…