Healthcare fraud enforcement ramps up in the Trump administration, with implications for all stakeholders
Even as hospital leaders consider how to manage decreased reimbursement and higher costs, federal fraud enforcement continues to have some of the most significant financial stakes of any healthcare industry issue. Rather than taking a hands-off approach, the Trump administration is maintaining and even expanding the Biden administration’s push in this area. Two months ago,…
CBO breaks down how and when the budget reconciliation bill will reduce insurance enrollment
The Congressional Budget Office (CBO) released its most detailed projections yet about how the budget reconciliation bill stands to affect healthcare coverage. According to data published Aug. 11 as part of a report requested by Democratic congressional leaders, the CBO estimates that 10 million people will be uninsured in 2034 because of the new law.…
Latest on the Blue Cross Blue Shield settlement: Numbers revealed on filed claims, opt-outs (updated)
Oct. 8 update The lead attorneys for the class of plaintiffs in the Blue Cross Blue Shield provider litigation are highlighting portions of the judge’s final approval of the $2.8 billion settlement, saying his comments should provide reassurance about the ability to bring future litigation against the Blues. Per the settlement terms, participants cannot sue…
Do bed-day shortages mean we need to build more bed capacity? Maybe not
As patients nationwide increasingly opt to seek care at large urban academic health systems (AMCs) recognized for their availability of specialized care and a higher quality of care, AMCs in the nation’s largest cities are beginning to experience significant bed-day shortages. In response, they are proposing to build new bed-day capacity. But simply building more…
Ahead of expected turmoil, the hospital sector is on solid footing
With uncertainty on the horizon for healthcare operations, hospitals and health systems appear to have established a stable foundation from which to respond to challenges. Recently reported financial data offers further indication that the not-for-profit (NFP) hospital sector has attained a measure of equilibrium several years after the pandemic and the ensuing turbulence in labor…
3 strategic alternatives to direct primary care physician employment
Hospitals continue to spend money employing their physicians — an estimated $312,528 per physician in the first quarter of 2025, up 6% from the same period last year, according to the most recent Kaufman Hall Physician Flash Report. The physician employment model is entrenched, but no health system can sustain losses of this amount over…
Key Senate committee eyes healthcare reform in the name of affordability
As described at a recent Senate hearing, hospitals, insurers and pharmacy benefit managers (PBMs) all are under scrutiny by Congress in efforts to curb the growth in healthcare costs. The Senate Health, Labor Education and Pensions (HELP) Committee held a July 31 hearing to examine ways to make healthcare more affordable for consumers and other…
Aetna’s new payment policy could leave hospitals at a disadvantage
Hospitals should take note of an insurer’s new approach regarding the two-midnight rule, especially given the potential implications if the policy becomes widely adopted. In a recent communication, Aetna said providers that contract with the company’s Medicare Advantage (MA) plans and Medicare Special Needs Plans face a new policy beginning Nov. 15 in instances when…
Optimizing the revenue cycle workforce: Balancing automation with empathy to elevate the patient experience
In today’s healthcare landscape, every financial conversation shapes not just patient satisfaction, but organizational trust. As health systems work to manage rising costs and operational complexity, revenue cycle teams find themselves carrying the dual burden of protecting financial performance while supporting patient experience, often without the resources to excel at either. Automation presents undeniable advantages…
Finalized regulations look to phase out the manual aspect of prior authorization
Medicare’s FY26 final rule for hospital inpatient payments includes the latest federal effort to streamline and improve prior authorization. The rule has a subset of regulations titled “Health Data, Technology and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization,” issued by HHS’s Assistant Secretary for Technology Policy and Office of the National Coordinator…