Both Democrats and Republicans recognize the overwhelming need to control healthcare expenses while maintaining and improving quality of care. Under the Obama administration, the Department of Health and Human Services (HHS) pledged that by 2018, half of traditional Medicare payments would be based on value-based payment models that incentivize high quality, low cost care as […]
Moody’s Investors Service 2017 Outlook for not-for-profit and public healthcare predicts stability over the next 12 to 18 months. Its analysts base projections on 0 to 1 percent operating cash flow growth and solid patient volume and revenue growth. Technology and operational investments, however, will continue to bring pressure on hospitals and systems. […]
Many questions have arisen about the future of the Affordable Care Act (ACA) since the election. From providers’ point of view, iProtean, now part of Veralon expert and Veralon Managing Director and CEO Dan Grauman noted the “repeal” of ACA probably will not eliminate alternative payment models (ACOs, bundled payments, etc.). Grauman noted in […]
As required by the Affordable Care Act (ACA), the Internal Revenue Service (IRS) reviews hospitals for compliance with Internal Revenue Code 501(r). Through June 30, 2016, 166 of the 692 completed reviews were referred for “field examination” for what appeared to be noncompliance with charity care requirements. Issues for which field examination referrals were […]
When you consider the medians of the hospitals/systems at the two ends of the rating scale—Aa and speculative grade—there is greater dispersion of minimum, maximum, mean and standard deviation in the FY2015 not-for-profit healthcare medians. Moody’s Investors Service analysts noted in one of its recent reports on healthcare medians that “continued consolidation and the aim […]
The threat from ransomware and other IT security challenges is expected to increase as hospitals acquire and hold ever-larger quantities of valuable patient electronic health records. The nature of the IT security threat changes so rapidly that ongoing education of hospital leaders is critical. Hospitals have looked for effective ways to keep their leaders […]
Nontraditional partnerships explicitly form to manage accountable care organizations and clinically integrated networks. Shared governance is typical in these types of partnerships. Other nontraditional partnerships include insurance companies, retailers and pharmacy companies. Accountable care organizations and clinically integrated networks both collaborate among hospitals and physicians to manage large groups of patients to reduce the […]
In several of our courses we have covered the trend toward hospitals entering nontraditional businesses such as health insurance or retail operations as a means to absorb the impact of value-based reimbursement. Several of our experts have discussed mechanisms for such businesses: collaboration with existing companies, joint ventures with varying degrees of control, acquisition of […]
Amid speculation about the outcome, The Department of Justice (DOJ), joined by a number of states, filed complaints on July 21 in federal district court challenging the mergers of health insurance giants Anthem and Cigna and Aetna and Humana. Attorney General Loretta Lynch announced the filing and noted that these deals would eliminate competition at […]
CMS issued a final rule last week that will allow accountable care organizations (ACOs) to benchmark their results to regional Medicare spending, using a phased approach to incorporating regional fee-for-service (FFS) expenditures into calculations for resetting, adjusting, and updating an ACO’s rebased historical benchmark after an initial three-year agreement period. National benchmarks will continue […]