Already struggling rural hospitals see an increasing financial threat from the steady growth in Medicare Advantage enrollment.
Why it matters: Lacking the bargaining powers of their larger peers who depend on commercial payers to turn a profit, some rural hospitals are losing money on private coverage like Medicare Advantage. The Medicare alternative's popularity with seniors is cutting into a typically better funding source for rural hospitals — traditional Medicare — as hundreds of rural hospitals face down financial calamity.
As a health care economist who studies innovation, and as a management consultant who helps health systems and insurers adopt new technologies, we have had a ringside seat to a frustrating phenomenon: The large private sector of the U.S. health system can move faster to adopt valuable innovations than the public sector burdened by red tape and politics.
But before adopting an innovation at scale, the private sector too often waits for the public sector to take the first step — sometimes for decades.
The No Surprises Act has protected patients from some of the most outrageous out-of-network medical bills since it took effect in 2022 — except for ground ambulances.
When it comes to certain medical conditions, we all have wrestled with the conflagration of differing opinions and the discrepancies in provider documentation.
A common example: The emergency department physician states sepsis, the attending physician writes pneumonia, and the infectious disease specialist documents viral infection. What gives? CDI specialists need to address these situations head on to obtain accurate, specific, and clear documentation. Why do these discrepancies occur and how can we address them?
Though medical schools may vary in how they teach clinical indicators, they follow generally recognized standards and guidelines for clinical practice. These standards are established by professional medical organizations and are based on evidence-based medicine and clinical research.
A number of services in the E/M category are on track for big pay gains in CY 2024, led by behavioral health care management (99484), set for a 26% jump to $54 per service, and joined by two prolonged services codes (99415, 99416).
But the good news isn’t everywhere. While the pay increases are significant for some services, a total of nine codes in the E/M family are part of the gains, according to a Part B News payment analysis factoring in the conversion factor cut and changes to relative value units (RVU) from the proposed 2024 Medicare physician fee schedule. That contrasts with dozens of E/M codes that will see reduced fees in CY 2024.
A bipartisan coalition of 51 senators has issued a letter to Senate leaders Chuck Schumer and Mitch McConnell to address and avert an $8 billion cut to the Medicaid Disproportionate Share Hospital (DSH) program, slated to begin on October 1 and continue for the next four years.
The reduction in DSH is one result of a series of legislative proposals enacted in May, which had advanced through the House Energy and Commerce Subcommittee on Health unanimously, 27-0.