When healthcare navigation needs clinical accountability
Healthcare navigation has become an important part of the employer benefits strategy. It can help employees understand coverage, find in-network providers, schedule appointments and work through administrative barriers. But access support and clinical care management solve different problems. That distinction matters when an employee’s need involves symptoms, medication concerns, a recent hospitalization or a worsening…
Profitability Under Pressure: How Senior Living CFOs Are Turning Margin Squeeze Into Strategic Growth
Download this infographic to uncover five key trends and benchmark your finance strategy against industry leaders.
Improving the healthcare system for women
Nick Hut talks about 2027 Proposed Rules for the Physician Fee Schedule with Katie Gilfillan. Erika Grotto interviews Terry Hush of Roji Health Intelligence about how the healthcare industry can better serve women.
Patient matching bill could save $2.5M per hospital
Support is growing in Congress and in the healthcare industry to enact a national patient matching framework that would save billions of dollars in denied claims for hospitals and health systems. Most recently, two U.S. Senators, Mark Warner (D-Va,) and Jim Banks (R-Ind.), introduced the MATCH IT Act, a companion bill to House Bill HR…
From data capture to denial prevention: Strengthen patient access upstream
Revenue loss is often discovered after adjudication, but the conditions that created it may have entered the account days or weeks earlier. An outdated coverage record, missing authorization or unresolved identity mismatch can pass through patient access and surface only when payment is delayed. By then, the organization is managing rework rather than preventing it.…
News Briefs: A small increase to hospital outpatient payments could be negated in 2027
Hospital outpatient departments and ambulatory surgical centers would receive a 2.4% base increase to Medicare payments in 2027, according to a CMS proposed rule published July 7. A 3.2% increase to the market basket would be reduced by 0.8% due to the mandatory economywide productivity adjustment. The numbers could change moderately when the final rule…
Nathan Kaufman: A tragedy of epic proportions looms for healthcare
Garrett Hardin popularized the idea of a tragedy of the commons in a 1968 Science essay carrying that title.a It describes a situation in which individuals with unlimited access to a public resource act in their own self-interest and ultimately deplete it. Hardin used grazing on a public pasture to make his point. Imagine a…
David Johnson: How synthetic scaling can help healthcare nonprofits achieve national scale
Two massive segments of the healthcare ecosystem operations — nonprofit health systems and nonprofit health insurance companies — have struggled to achieve operations at the national level. These organizations consistently find it difficult and time-consuming to merge, and as a consequence, neither has achieved national scale. This situation compromises nonprofits’ capacity to generate operating economies and create value for their customers.…
Health system capital planning: Not for the faint of heart
The past decade has seen hospital finances whipsawed by a global pandemic, a record-setting multi-hundred-billion-dollar cyberattack, a more than 20-year record surge in labor costs and a trillion-dollar cut in federal Medicaid spending. Not surprisingly, hospital credit has deteriorated. Hospital finances cumulative rating activity, quarterly trend Yet hospital capital spending is soaring.a Capital spending for…
Healthcare’s new velocity: Are you ready?
For decades, our nation’s health systems have pursued a strategy of what I call “controlled deceleration,” which acknowledges innovation while slowing it to a pace that has preserved existing power structures. That strategy no longer works. The passage of the One Big Beautiful Bill Act (OBBBA), in combination with other powerful forces, is bringing high-velocity…