Walmart Health’s demise is emblematic of the nation’s primary care conundrum
Walmart’s announcement on April 30 that it was pulling the plug on Walmart Health stunned the healthcare ecosystem.a Few saw it coming. Launched amid much fanfare in 2019, Walmart Health has operated 51 health centers in five states, with a robust virtual care platform. Walmart’s news release noted that “the challenging reimbursement environment and escalating…
CMS’s 2024 MA rule brings some improvements but falls short of addressing all providers’ concerns
Hospitals and other healthcare providers welcomed CMS’s release in 2023 of the 2024 Medicare Advantage and Part D final rule (CMS-4201-F).a The rule represents CMS’s effort to refine the practices of MA organizations by placing limitations on prior authorization, elevating requirements for provider directories and making comprehensive adjustments to the MA and Part D quality…
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Learn about a company that combines advanced technology with human interaction to increase recoveries and patient satisfaction.
News Briefs: A second appeals court rules against providers in the 340B contract-pharmacy dispute
A decision issued by an appeals court represents the latest setback for 340B providers seeking to secure price discounts on Medicare Part B drugs. The D.C. Circuit Court of Appeals on May 21 upheld a district-court ruling that drug manufacturers can impose restrictions on the 340B discounts they provide for drugs dispensed at contract pharmacies.…
HFMA’s editorial team earns 19 awards for excellence
HFMA has been honored with a total of 19 awards of excellence for various editorial pieces produced and published in 2023. The recognized pieces were as follows: “We know the original content our editorial team produces, including hfm, online posts, blogs, monthly newsletters and podcasts, is valuable to our members because you tell us so…
How one health system focused on revenue cycle staff education to improve its denial rate
Many longtime revenue cycle leaders can recall a simpler time when insurance companies sold plans that were broadly accepted by providers in their service areas. Back then, hospitals provided services to patients, billed their health insurance plans and expected relatively prompt payment. This is no longer true. Today’s revenue cycle team members must be knowledgeable…
Ken Perez: How 3 presidential candidates are defining their prescription drug pricing policies
What do voters care most about? It’s arguably the most salient question in every election cycle. Each March, to answer that question, Gallup asks Americans to rate their concern about a variety of national issues. This year’s survey asked respondents about 14 different issues.a Inflation came out on top, with 55% of those surveyed worrying…
Change is inevitable: What are you doing about it?
Strategies evolve. Operations evolve. Leadership concepts evolve. That’s the circle of life in the healthcare industry. Ongoing changes can affect what healthcare leaders focus on from one year to the next. That idea might well be encapsulated in the differences between what the CFOs featured in this column in FY2022-23 cited as their suggested guiding…
What health systems need to know about partnering to develop an ASC strategy
Health systems must contend with conflicting imperatives. While remaining intensely focused on day-to-day operations and financial viability, they cannot ignore longer-term strategic imperatives, which may include building out a full continuum of care to succeed under value-based payment while maintaining market relevance. Yet many health systems face significant impediments to broadening the continuum of care,…
The key role of downside risk in the success of value-based care
The basic idea behind value-based care (VBC) is simple. By encouraging providers to focus on the value rather than the volume of the services they deliver, it should be possible to achieve the twin goals of lowering healthcare costs and improving clinical outcomes. Given that the United States now spends far more per capita on…