GAO examines No Surprises Act payment and network trends
Recent trends seen as a consequence of the No Surprises Act (NSA) include a moderate increase in the share of providers going in-network for some services, according to a report by the Government Accountability Office (GAO). Such a development was a secondary goal of the 2020 year-end legislation and could belie concerns that the large…
Medicare GME funding reform debate focuses on rural hospitals
Better-targeted funding is essential to ensure the clinical talent pipeline meets the needs of hospitals in rural and underserved areas, according to insights at a recent congressional hearing. Phelps Health, a rural Missouri hospital, has benefited from federal and state planning and development grants that enabled the launch of a family medicine residency with enhanced…
Relief might be fleeting for the healthcare industry after Supreme Court strikes down most tariffs
The Supreme Court decision striking down most of the Trump administration’s tariff policy negated many of the tariffs that have affected healthcare and other industries since beginning in August 2025. The high court issued a 6-3 ruling Friday that found tariffs initiated under the International Emergency Economic Powers Act (IEEPA) are invalid because the statute…
Rising healthcare costs strain health system margins
Systemic challenges are showing few signs of easing in healthcare financial operations. As identified by federal actuaries, increases in the use and intensity of hospital services drove a big recent jump in national healthcare spending. Those volume-based metrics represent a boost for hospital revenues but a roadblock to cost reduction. That dichotomy had a net…
Hospitals mount response as site-neutral payment policy progresses
Hospitals and their advocates think the concept of site-neutral payment is gaining enough traction in policy circles that a strategic response is warranted. One step in attempting to stanch the apparent momentum of site-neutral policies is the release of a new report that finds recommended approaches would cut hospital payments by $182 billion over 10…
CMS provides more leeway to Medicaid state-directed payments before new limits kick in
CMS issued guidance that expands the opportunity for providers to receive a key Medicaid supplemental payment at a higher rate over the next two years. The bulletin regarding Medicaid state-directed payments (SDPs) makes it easier for states to maintain eligibility for higher SDPs before the legislation known as the One Big Beautiful Bill Act (OBBBA)…
Transparency in Coverage proposed rule aims to make price files more usable
HHS’s proposed updates to health plan price transparency files mark a notable step in ensuring the information is useful for providers and other healthcare stakeholders, experts say. The Transparency in Coverage (TiC) proposed rule issued in December would modify requirements for health plans with an eye toward making the massive machine-readable files (MRFs) more navigable…
CMS proposes 2027 ACA marketplace changes to address rising premiums
With few signs of pending relief for increased premiums in the Affordable Care Act (ACA) insurance marketplaces, CMS issued proposals designed to solidify the affordability and availability of coverage next year. In recent weeks, the Senate has made little or no announced progress on agreeing to an extension of the enhanced subsidies for buying ACA…
Capital expenditures surge amid aging facilities
Several health systems and hospitals are boosting capital expenditures amid a long-term aging trend in the physical plant of those organizations. The average age of plant for not-for-profit hospitals and health systems reached 12.7 years in FY24, among organizations rated by Fitch Ratings. That was the oldest average in at least 13 years. The age…
Updated documentation requirements in Medicare could add burden on healthcare providers
Citing concerns about improper payments, CMS issued a regulatory update that expands Medicare prior authorization and other documentation requirements starting April 13. The regulations are most meaningful for vendors of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), but the operations of hospitals and other front-line providers stand to be affected as well. Increased documentation…