Senate committee examines ways to strengthen the supply chain for hospital drugs
Vulnerabilities in the supply chain for pharmaceuticals are putting patients at risk and hampering healthcare providers, according to testimony at a recent Senate hearing. The flaws manifest in shortages of vital drugs and in issues of quality and transparency, experts said during the Oct. 8 hearing of the Senate Special Committee on Aging. In Q1…
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…
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…
Report by HFMA and Eliciting Insights examines hospitals’ journey to realize the potential of AI
Although healthcare AI technology has been in the pipeline for years, new feedback suggests implementation remains a work in progress at hospitals and health systems. As described in an HFMA report produced with Eliciting Insights, most organizations are still striving to develop an AI strategy and install an AI governance structure. Findings of the report…
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,…
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…
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…
News Briefs: Budget reconciliation bill finalized with big implications for Medicaid
Declines in coverage and spending await the healthcare industry under the budget reconciliation bill signed into law by President Donald Trump on July 4. The Congressional Budget Office (CBO) projects $912 billion in reduced Medicaid spending and 10 million additional uninsured Americans in 2034 as a result of the law known as the One Big…
Soaring charity care grabs hospital leaders’ attention
Across the country, hospitals are reexamining their approach to uncompensated care, with first movers in this space increasing the availability of financial assistance and working harder to reduce the chances that an account will be sent to collections. And now, new data paints a picture of the collective impact of these efforts and other trends…
Reeling payers plan to increase scrutiny of providers’ coding practices
Health insurers see provider coding practices as one factor in unfavorable cost trends, several companies said during recent earnings calls. Those cost trends, in turn, have driven substandard Q2 financial results. “We know this adjustment is disappointing, and we’re taking concrete actions to address it,” Gail Boudreaux, president and CEO of Elevance Health said recently,…