ACA marketplace coverage changes reduce hospital revenue, shift payer mix
Changes to reimbursement in government healthcare programs are starting to show up in hospital financials, based on Q1 reporting from the for-profit hospital sector. Most notably, 2026 cutbacks in Affordable Care Act (ACA) marketplace coverage are manifesting in lower revenues, while hospitals are getting a taste of what’s to come next year in Medicaid coverage.…
The Revenue Cycle of the Future: AI boom and workflow redesigns accelerate rev cycle transformation
Hospitals of all sizes are leveraging AI advancements and workflow redesigns to modernize revenue cycle management, aiming to lower costs, improve operational efficiency, and enhance the patient experience. While technology such as predictive analytics and automation shows promise in streamlining tasks, challenges remain in workforce adaptation, skill shifts, and the need for strategic collaboration, as leaders work to balance innovation with employee training and retention in an increasingly tech-driven environment.
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…
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…
Hospital use and service intensity helped fuel healthcare spending growth in 2024
Increasing use and intensity of hospital care, physician and clinical services, and retail prescription drugs led a continued surge in U.S. healthcare spending in 2024, according to newly released data. National health expenditures (NHE) reached $5.3 trillion, a 7.2% increase year-over-year and comparable with the 7.4% jump recorded in 2023. Except for the pandemic year…
Hospital-insurer contract disputes could intensify as cost pressures persist
Relationships between hospitals and health insurers are expected to undergo further strain this year, according to analysts with a leading credit ratings agency. “Providers are still dealing with rising operating costs, labor supplies and infrastructure that outpace what insurers have been willing to pay in recent years,” said Bradley Ellis, senior director for the U.S.…
MedPAC finds the hospital industry is on a more stable financial footing now
Hospitals do not need a Medicare payment boost for 2027 beyond the update to be provided in the statutory formula, says the Medicare Payment Advisory Commission (MedPAC). Whereas the commission had recommended that Congress increase hospital payments by an additional 1% or 1.5% ahead of each year from 2024 through 2026, the recommendation for 2027…
Economic trends affect patient volumes at two large health systems
Macroeconomic factors are causing a moderate drop in demand for healthcare services, according to insights from executives with a pair of leading for-profit hospital chains. At Community Health Systems (CHS), the first quarter of 2025 brought strong hospital volumes, but those dipped during the middle part of the year. Same-store adjusted admissions were 0.7% lower…
The Healthcare C-Suite of the Future: From AI to ROI–Emerging needs drive demand for new skillsets
Read this report on how healthcare C-suite leaders face growing pressures to adapt to rapid technological advancements and unsustainable costs. AI, innovation, and payer relations are key areas for focus.
How specialty drugs are remaking healthcare and driving up costs
This article has been updated with news of additional policies announced by the Trump administration. Accelerating healthcare costs have less to do with traditional hospital and physician services than with surging drug spending, an industry expert says. “When we can’t really see any trends in healthcare utilization increasing, the only thing that consistently shows up…