How predictive analytics and AI shed light on payer behavior
Providers and payers have become more collaborative as payment models evolve toward value. Still, payer-provider relationships can seem one-sided — decidedly in favor of the payer — as hospitals continue to face declining reimbursement and rising costs. The increase in denials is a great example, with rates skyrocketing by 20% over 5 years, according to…
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…
Money received through the Provider Relief Fund could be at risk as audits ramp up
Recipients of Provider Relief Fund (PRF) distributions and COVID-19 Uninsured Program payments should be girding themselves for audits, legal experts say. The programs represent “a two-front audit fight that providers are facing and will face in the coming years,” Brian Lee, partner with Alston & Bird, said during an Aug. 24 webinar hosted by the…
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…
The evolution of telehealth and the potential for sustainability
The surge in use of telehealth services seen during the pandemic has slowed, but telehealth remains a key modality amid policy changes that will help set the course for the future of virtual care. “There’s no alternative,” said Kyle Zebley, senior vice president for public policy with the American Telemedicine Association (ATA) and executive director…
Summary: 10 vital responses to healthcare disruption
Note: This article is a summary of a report on HFMA’s Spring Thought Leadership Retreat. The full report is available to download. Disruption is reverberating throughout the healthcare industry, and it’s incumbent on legacy organizations to develop strategic responses for the benefit of their consumers, their communities and themselves. With that overarching challenge becoming ever…
News Briefs: Hospitals foresee adverse impacts from the FY24 inpatient payment rule
The FY24 final rule for Medicare inpatient payments didn’t bring hospitals the type of rate update they had sought, and for some organizations, a bigger concern is changes to uncompensated care (UC) payments. The regulations, which take effect Oct. 1, establish a 3.1% increase in operating payment rates, on average, for hospitals that meet quality-reporting…
Prices of drugs for diabetes, heart failure and more will be up for negotiation in Medicare next year
The U.S. Department of Health and Human Services (HHS) on Tuesday announced the first 10 Medicare Part D drugs that will be subject to price negotiations, the headlining healthcare-related provision of the Inflation Reduction Act. Signed in August 2022, the law gave Medicare authority to negotiate with drug manufacturers over the prices of selected drugs.…
8 Chapters receive 2023 HFMA Success Awards
Each year, leaders of HFMA’s chapters and regions gather at the Leadership Training Conference to plan for the year ahead and to acquire the skills and resources needed to go back home and make it happen. This year’s event took place April 16-18 in San Antonio, Texas. One of the highlights was the volunteer recognition…
Ken Perez: How homelessness and healthcare are inextricably linked
Homelessness is a worsening problem for the United States, and in multiple ways, it is a healthcare issue. Many of our nation’s failed efforts to solve this problem, outlined below, do not fully acknowledge this reality. But a promising new not-for-profit initiative, Built for Zero, may provide a truly viable solution using a data-driven approach…