New data on national healthcare spending highlights the constraints facing hospitals
Recently published 2022 data indicates relatively restrained national healthcare spending as the COVID-19 pandemic faded, especially in the hospital sector. The increase in spending on hospital services slowed from 4.5% in 2021 to 2.2% in 2022, CMS actuaries reported Dec. 13 in Health Affairs. The increase was significantly less than in 2020 (6.2%) and the…
Key Senate committee takes a close look at healthcare waste and prices
The U.S. Senate is intent on finding ways to improve the value of healthcare, according to takeaways from a recent hearing of the Budget Committee. Although other committees and subcommittees in both chambers of Congress have held meaningful hearings about healthcare policy and costs this year, the Budget Committee’s attention to the matter is especially…
Prior authorization in Medicare Advantage remains in the policy spotlight as 2024 regulations take effect
Healthcare policymakers and stakeholders continue to mull the need for guardrails to ensure optimal customer service among Medicare Advantage (MA) health plans. The American Hospital Association wrote a Nov. 20 letter to CMS stating that MA plans are looking to skirt policies designed to ensure straightforward coverage of essential healthcare services. These policies, finalized earlier…
With No Surprises Act independent dispute resolution changes pending, provider reps voice systemic concerns
The No Surprises Act’s arbitration process continues to be hampered by parties that don’t always follow the regulations, stakeholders expressed to CMS on Thursday. The agency hosted a forum to describe changes being made to the arbitration process, also known as independent dispute resolution (IDR). A proposed rule issued Oct. 27 introduces various technical changes…
News Briefs: Medicaid DSH payment cut barely averted in September, still possible in November
Hospitals received a last-day reprieve from substantial cuts to Medicaid disproportionate share hospital (DSH) payments, with House leaders reversing course Sept. 30 and ushering through a six-week government funding package. Language in the bill ensured the start of a four-year Medicaid DSH cut amounting to $32 billion was pushed back from Oct. 1 to Nov.…
HHS: Insurers won’t be penalized if they don’t update their No Surprises Act qualifying payment amounts as required
Providers may not immediately benefit from a favorable court ruling that affects the methodology for determining the qualifying payment amount (QPA) under the No Surprises Act. The U.S. Department of Health and Human Services (HHS) issued guidance Oct. 6 that says the Biden administration will not enforce the court decision until at least May 1.…
HHS sets new administrative fee to be paid by parties in No Surprises Act independent dispute resolution cases
Oct. 6 update: The lead section of this article was updated where noted with news about the arbitration portal. The administrative fee for taking out-of-network payment disputes to arbitration under the No Surprises Act in 2024 would be significantly lower than it was for much of 2023, but triple the current rate, according to proposed…
American providers remain in reimbursement limbo during IDR failure
HFMA and its member healthcare providers are growing more concerned over the extended delay of reimbursement from group health plans subject to the unresolved No Surprises Act IDR regulations and guidance. HFMA members continue to report that numerous health plans persist in determining very low rates for calculating the Quality Performance Assessment (QPA) they are…
Published data quantify how cost increases will continue to affect the healthcare industry next year
The cost to treat patients will accelerate next year, with ramifications across the healthcare industry, according to newly published projections. PwC’s Health Research Institute reported that the cost of providing care will increase by 7% in 2024, up from a 6% increase this year and 5.5% in 2022. A 7% increase would tie 2021 for…
A crisis of faith regarding value-based care
As the movement to reduce or eliminate fee-for-service payment in favor of value-based payment plods along, some in the industry are voicing doubts that it is ever going to happen or that it is even necessary. An HFMA survey conducted in February and March for the “Healthcare 2030” series of special reports finds some of…