9 features of a revitalized healthcare workforce
As the 2030s approach, the horizon looks daunting for the healthcare workforce. Consider these trends: The entire baby boomer generation will be eligible for Medicare coverage by the turn of the decade. Clinician shortages are projected to be well into the six figures by 2034, accelerated by a reported exodus of 145,000 clinicians in 2021…
As transparency rules enter their fifth year, advanced uses gain traction
With price transparency rules becoming more entrenched in the healthcare system, applications are growing more sophisticated. “There’s this treasure trove of data out there, and a lot of interest in how it can best be leveraged to support not just consumers but also broader policy goals to improve healthcare affordability,” Sabrina Corlette, JD, co-director of…
Hospital financial and revenue cycle benchmarks paint a complicated picture heading into the new year
The tail end of 2024 has brought promising news regarding hospital financial metrics, even as revenue cycle indicators suggest continuing strain. Margin data are showing moderate improvement, and one of the three credit-rating agencies has upgraded its 2025 sector outlook for not-for-profit (NFP) hospitals and health systems. Fitch Ratings announced this week it was revising…
The state of U.S. primary care: Daunting challenges, achievable solutions
Value-focused efforts to shore up primary care require bold initiatives that increasingly are being implemented but continue to encounter obstacles, according to insights from a recent conference. “We have answers in a kind of amazing array of [physician] practices all over the country that are generally doing an aligned thing,” said Asaf Bitton, MD, associate…
HHS watchdog flags improper payments to hospitals for services provided to hospice patients
Hospitals may face closer scrutiny over a segment of Medicare outpatient billing after the HHS Office of Inspector General (OIG) found improper payments. In a report posted Nov. 18, OIG found that improper payments were prevalent for outpatient services provided to hospice enrollees during a five-year period ending in 2021. Examining a sample size of…
What the site-of-care shift for joint replacement means for hospitals
Hospital patient volumes mostly have been on an upswing since the worst of the COVID-19 pandemic, but certain trends represent cautionary tales for long-term finances. For example, the latest report (registration required) from Strata Decision Technology shows a year-over-year decline in August of more than 21% for inpatient primary knee replacement procedures. A shift to…
Report suggests the extent to which Medicare Advantage health plans are skirting the two-midnight rule
As hospitals struggle with payer tactics involving denials, a new analysis quantifies the extent to which Medicare Advantage (MA) health plans still avoid paying for inpatient care. The report by Kodiak Solutions examined claims data from more than 1,900 hospitals and found that MA plans categorized hospital visits as outpatient observation stays at a rate…
Providers can expect UnitedHealthcare to undertake closer inspection of coding patterns
Healthcare spending that exceeded expectations is motivating UnitedHealthcare to take a more rigorous look at provider coding practices. For two consecutive quarters, parent company UnitedHealth Group (UHG) has reported that the medical-cost ratio (MCR) of UnitedHealthcare is being impacted by several factors. One is provider coding trends, the company’s leaders said during investor calls. “In…
Despite positive outcomes, coverage of GLP-1 drugs presents complicated questions
The drugs known as GLP-1 receptor agonists bring the potential for improved health to millions but also a bevy of questions and challenges concerning cost and coverage, according to insights in a recent webinar. GLP-1s such as Ozempic and Wegovy initially came to market as a way to control blood sugar for people with type…
Reports on healthcare labor trends indicate an improved outlook for hospitals
The labor picture continues to stabilize for hospitals even amid sustained high demand for healthcare services, according to new insights. In its latest labor tracker, Fitch Ratings reported that hospital staff payrolls have been steadily expanding and now represent a 6.7% increase relative to the pre-pandemic month of February 2020. Hospitals added 18,650 jobs per…