Hospitals get wins on price cap bills
Hospitals scored victories recently in the ongoing push across multiple states for price caps for their organizations. The 2026 legislation followed three states that enacted hospital price caps in 2025. A total of 13 states considered reference-based hospital pricing legislation last year, according to tracking by the National Academy for State Health Policy. Delaware delay…
White House zooms in on hospital contracts
The Trump administration is tightening scrutiny of provisions of contracts of hospitals with payers, which could spur additional lawsuits or legislation, say attorneys. The White House Council of Economic Advisers issued a June 18 memo laying out its case against health systems’ use of several contract provisions focused on: The memo couched a nationwide ban…
FastFinance: AI in the ED; ACA plan pressure could hit providers
HFMA’s FastFinance newsletter is now a podcast. Host Rich Daly discusses the most current and relevant healthcare news, delivered in an easily digestible format. An AI tool helped cut emergency department lengths of stay, a recent study found. That improvement demonstrates the technology’s potential to drive operational efficiency, says one of its authors. Also, this…
AI moves beyond revenue cycle
An AI tool helped to cut emergency department (ED) lengths of stay (LOS), a recent study found. That improvement demonstrates the technology’s potential to drive operational efficiency, says one of its authors. The prospective study, which was published last month in the journal Nature, used an AI model to predict hospital admission risk for ED…
ACA plan financial struggles could hit providers
ACA marketplace plans lost $5.5 billion in 2025 — despite record enrollment and before extra subsidies expired, according to new data. Their course-correction strategies could hit hospitals and health systems. The individual segment plans suffered a $5.5 billion underwriting loss in 2025, according to an analysis of insurance filings by Mark Farrah Associates. That compared…
What the Trump administration told finance leaders
Several high-level healthcare officials from the Trump administration, including the CMS administrator, addressed various components of health policy at the HFMA Annual Conference last week. Their comments provided some insights on how the administration thinks about policy, industry trends and innovations. ‘Definitely not terminal’ Mehmet Oz, MD, administrator of CMS, said the “breakthrough ideas” of…
Health systems approach risk with payers
Health systems are finding different interest and approaches to downside risk in value-based care (VBC) among health plans in their markets. Mark Bortnem, CFO of Essentia Health, said some of their payers have clinical teams that will partner with Essentia’s medical leadership to strategize collectively about how to reduce low-value care and avoidable care. However,…
FastFinance: Provider plan challenges; Digital diversion tool
HFMA’s FastFinance newsletter is now a podcast. Host Rich Daly discusses the most current and relevant healthcare news, delivered in an easily digestible format. Hospitals and health systems have launched an increasing number of health plans in recent years and now provider plan challenges mean they need major re-assessments and decisive action. Also, this week’s…
Not dead: Provider-sponsored plans reassessing
Provider-sponsored health plans (PSHPs) proliferated in recent years and now face a historically challenging market. Some are reassessing, while others are in wait-and-see mode, says an adviser. From 2018 through 2023 the number of hospitals owning PSHPs increased from 692 (18.3% of hospitals) to 834 (27.2%), according to a new study published in JAMA by…
Amid ED surge, hospitals add diversion tools
Surging emergency department (ED) volumes have led a growing number of health systems to launch digital tools to divert nonemergent patients to alternative sites of care. Hospital ED volumes have increased 25% since 2021, according to the medians [subscription required] of rated hospitals tracked by Moody’s Investors Service. High ED volumes have resulted in overcrowding…