6 actions for physician practices on signing risk-based contracts
Physician practices are continuing to make the move into value-based payment, and for many, such contracts will present a substantial learning curve.
CMS issues RFI to gather best practices for identifying and supporting safety net hospitals
As part of the FY24 proposed rule for hospital inpatient payments, CMS is seeking healthcare stakeholder input on how to best support safety net hospitals in the Medicare program. The agency is considering ways to reimburse safety net hospitals via supplemental payments that may be better targeted than disproportionate share hospital (DSH) and uncompensated care…
Hospital price transparency updates include stricter enforcement, new fines and pending legislation
(Note: The last section of this article was updated May 24 where noted to reflect developments in Congress.) Enforcement of hospital price transparency regulations is becoming stricter, with CMS implementing new policies and recently fining two hospitals. Changes were anticipated after CMS leaders authored an article in February that reported 70% compliance in 2022, the…
Congress seems inclined to expand site-neutral payment policies in Medicare (updated)
Momentum is building in Congress toward expanding site-neutral payment in Medicare, a move that could reduce payments to hospitals by billions of dollars per year. A recent hearing, which lasted 5 ½ hours, focused on various ideas for promoting transparency and competition in healthcare. The hearing included references to 17 bills or discussion drafts, several…
The COVID-19 public health emergency is over: Here’s what healthcare providers should know
An era ends for the U.S. healthcare industry with the termination of the COVID-19 public health emergency (PHE) at the close of the day on Thursday, May 11. The termination means providers are losing many of the federal waivers and flexibilities that have been in place for all or most of the PHE, which took…
New data on No Surprises Act arbitration cases show providers are faring well amid systemic challenges
Providers are having success at challenging out-of-network payment amounts under the No Surprises Act, at least when they can get their cases through the arbitration system. CMS published an update showing that between April 15, 2022, when the independent dispute resolution (IDR) portal opened, and March 31, arbitrators issued payment determinations in 42,158 disputes. Initiating…
Harris Affinity Decision Support can help healthcare leaders identify meaningful areas for improvement
Improve your healthcare organization by leveraging advanced cost, performance, reimbursement and profitability data to inform and drive critical financial, operational and clinical decision-making.
How managed care contracting strategies promote operational resilience
Read this article for an in depth look on several strategic steps for healthcare leaders to take to benefit their organization's managed care contracting.
Susan Dentzer: Perspectives differ on Medicare’s 2 houses
Drive through rural New England and you’ll see them: “connected farms,” cobbling together houses, sheds, barns and outbuildings in disjointed structures. Often centuries old, they are at once unlovely, yet exude charm. To me, they’re a perfect metaphor for the jumble of Medicare. How else does one describe a program that baffles new enrollees as…
News Briefs: Medicare’s proposed FY24 update to inpatient payments falls short, hospitals say
Hospitals are less than pleased with Medicare’s proposed FY24 payment increase for inpatient care. In regulations released April 10, the net inpatient payment update is 2.8% after factoring in a mandatory productivity adjustment of -0.2 percentage points. As usual, the update would be reduced for any hospital that does not fulfill quality-reporting requirements or qualify…