Expert Reviewed

Articles vetted and approved by hfm magazine editors and industry experts.

Not-for-profit health systems need a new enterprise strategy

Based on findings of recent original research, the current financial performance of not-for-profit (NFP) health systems raises concerns over their long-term financial viability. The research findings underscore the need for NFP health system leaders to reconceptualize their organization as comprising six strategic business units (SBUs) and then manage each in terms of competitiveness. Research findings…

Jim Price April 30, 2024

How to promote patient loyalty by improving network integrity

To achieve enduring financial stability, health systems must pursue initiatives to improve margins. And a particular priority for them is to focus on improving the integrity of their provider networks, with the goal of building patient loyalty to the larger healthcare organization. The first step in such an effort should be to perform a network…

Shawn Williams, FHFMA, CPA April 29, 2024

How providers can optimize payer contract negotiations

Negotiating payer contracts can be both challenging and frustrating. Payers have significant leverage at the bargaining table, enhanced by payer consolidations and the emergence of dominant local, regional and national plans. But by adopting a transparent data-driven strategy in negotiations with a payer, a provider organization can create an opportunity for building a strong partnership…

Scott G. Ellsworth, MBA March 29, 2024

8 healthcare trends for 2024: A guide for health system leaders and their boards

As health systems progress through 2024, they will require effective governance to successfully navigate the rising headwinds. As they plan and execute initiatives, their leaders and boards should remain informed about eight key trends that will have a growing impact on the industry and the future success of their organizations. 1 Continued big technology M&A…

Daniel J. Marino March 23, 2024

How a payer-provider collaboration around quality reporting can reduce costs and improve outcomes

Too often today, relations between provider and payer organizations can become contentious around issues related to payment and quality of care. Yet such conflict does not serve patients well, because it deflects these organizations’ attention from their underlying shared purpose: To work together to deliver well-coordinated, cost-effective healthcare to patients. With this purpose in mind,…

Brian Wheeler January 24, 2024

How CFOs can bring the rigor of finance to the call center

Health system call centers are universally acknowledged as significant cost centers. Too often, however, they are viewed as non-revenue-generating cost centers. In fact, a call center’s performance also affects revenue growth factors such as clinician utilization and patient loyalty. Despite the multiple ways that call centers affect both the bottom and top lines, there is…

Yuriy Kotlyar October 31, 2023

4 common misconceptions about observation that have revenue implications 

Among the many things that healthcare providers must document, few are as misunderstood and cause as much confusion as observation. Clearly, observation is often required as part of diagnosing and treating a disease or condition. The challenge for providers is that ambiguity and variability in regulatory and contract language create confusion regarding how to record…

Ronald Hirsch, MD, FACP, CHCQM September 28, 2023

Can MRF data be used for comparative benchmarking?

The impetus for the MRF requirement — as outlined by the U.S. Department of Health & Human Services (HHS) in its 2019 hospital price transparency final rule — was to enable informed decision-making about healthcare services based on their pricing, thereby helping to drive down the cost of healthcare. Yet significant obstacles continue to block…

Fred Stodolak September 22, 2023

Key questions for providers after more than 2 years of the price transparency rule

Evidence amassed from over two years of experience with compliance reinforces why providers need to focus on chargemaster prices and self-pay discount policies — and how they can benefit from analyzing trends in consumers’ price searches.

Fred Stodolak August 25, 2023

Why it’s so essential for hospitals to embrace a value-based payment strategy

dealing with myriad severe short-term operating strains, such as workforce shortages, to existential threats to their long-term future, including being cast as the enemy in the fight against rising healthcare costs, hospital leaders are struggling to maintain their organizations’ financial sustainability.

Brian Fuller, MA June 12, 2023
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