The health solutions company reported net income of $2.95 billion, a significant increase from the $2.78 billion posted in the second quarter of 2021, while revenue rose to $80.64 billion, compared to $72.62 billion over the same period last year.
For the year, CVS Health has brought in $157.5 billion in total revenue, up 11% from 2021, illustrating that the company's strategy of adding more health services is delivering results.
"Despite a challenging economic environment, our differentiated business model helped drive strong results this quarter, with significant revenue growth across all of our business segments," CVS Health president and CEO Karen Lynch said in a statement. "The continued success of our foundational businesses accelerated our strategy to expand access to health services and help consumers navigate to the best site of care."
CVS Health also revealed its plans of expanding individual coverage under the Affordable Care Act to four new states in 2023.
The news was delivered in the company's earnings call, in which Lynch announced the company's Medicare Advantage membership hit the 2 million milestone in the second quarter, including dual eligibles.
"As we continue to build our individual exchange business, we're on track to expand coverage where we currently have individual exchange offerings and are obtaining final approval to add four new states to our portfolio, bringing our total to 12 states," Lynch said.
Both hospital groups stressed the importance of the waivers for providing care to patients during the COVID-19 pandemic, as well as allowing providers the necessary flexibility during a difficult climate rife with challenges such as the labor shortage.
In the letter to HHS secretary Xavier Becerra, FAH urged for the PHE to be renewed another 90 days when it expires in October, with another 90 day-day extension in the works if necessary. AHA, meanwhile, asked for the PHE to be continued without specifying a renewal length in their penned response.
Pointing to the waivers specifically, AHA outlined several benefits for patients and providers, including hospital-bed flexibilities and relief from administrative burdens.
"Additionally, the PHE declaration has allowed for several critical coverage and hospital payment policies, including a 20% DRG add-on payment for COVID-19 patients, new technology add-on payments for new COVID-19 therapeutics, an enhanced Federal Medical Assistance Percentage (FMAP) rate of 6.2% for states," AHA wrote. "Ending the PHE prematurely would place our hospitals in an extremely challenging position and would directly affect our ability to care for our patients and communities."
AHA cited responses from hospitals and health systems to their survey, which showed that 93% of respondents said their hospitals would be impacted if the waivers were rolled back, with 60% indicating it would be significant. Another 89% said they still depend on the flexibilities provided by the waivers to deliver needed care.
FAH argued that the waivers have transformed the healthcare system by encouraging new technologies to modernize delivery of care and accelerating adoption of alternative care models.
In the letter, FAH also listed key waivers and policies that it wants made permanent, spanning remote services, clinical services, lab services, discharge planning, behavioral health, physician self-referral, workforce, and increased capacity.
"Indeed, the PHE has already served as a bridge to CMS' efforts, which we strongly endorse, to transform certain temporary waivers into permanent Medicare policy, some of which may require Congressional action to avoid any disruptions," FAH stated.
Several groups have backed the Seniors' Timely Access to Care Act, which will now head to the House floor.
The Seniors' Timely Access to Care Act continues to receive support as it moves to the full House after the House Ways and Means Committee unanimously voted to advance the bill.
The voice vote now tees up the legislation for a floor vote in the fall, with the bill receiving over 300 co-sponsors and the endorsement of over 500 organizations.
If passed, the bill would establish requirements and regulations for prior authorization under Medicare Advantage plans, such as establishing an electronic prior authorization program that includes the ability to provide real-time decisions in response to requests for items and services.
Several groups, from providers and payers alike, have advocated for the bill to improve the streamlining of the administrative process.
"These policies to streamline MA prior authorization requirements by eliminating complexity and promoting uniformity would reduce the wide variation in prior authorizations methods that frustrate both patients and providers. Thank you for your support to improve the prior authorization process to increase patient access to care and reduce burden for providers."
"Most importantly, the additional sections of the legislation mandating MA plans to issue faster prior authorization decisions are crucial policy improvements that will ensure more timely access to care and, as a result, improved patient health care outcomes and better stewardship of scarce Medicare resources. The AMA supports the requirements for health plans to provide real-time prior authorization decisions for routinely approved services, as defined in implementing regulations."
“MGMA strongly supports the Improving Seniors’ Timely Access to Care Act of 2022," said Anders Gilberg, senior vice president of Government Affairs at MGMA. "If enacted, this legislation would significantly improve a prior authorization process that is overused, costly, onerous, inefficient, opaque, and, most critically, responsible for dangerous delays in the delivery of necessary patient care. By establishing an electronic prior authorization program for Medicare Advantage (MA) plans, medical groups will have less administrative burden and can appropriately focus attention back on the patient."
“H.R. 8487 will build on the work the Medicare Advantage community has already undertaken to modernize prior authorization while protecting its essential function in facilitating highvalue, clinically appropriate care," said Mary Beth Donahue, president and CEO of the Better Medicare Alliance. "We urge members of the Ways and Means Committee to vote ‘yes’ and look forward to continuing to partner with our bipartisan champions in Congress to secure passage of this bill on the House floor in short order.”
The company suffered a rough second quarter with decreases across the board year over year.
"Challenging operating dynamics" between lower than anticipated volume and significant contract labor costs resulted in a difficult second quarter of the year for Community Health Systems.
The Franklin, Tennessee-based company reported a net loss of $326 million in its Q2 earnings report, which marks a sizeable decline from the $6 million in net income over the same period in 2021.
Operating revenue, meanwhile, was $2.93 billion, representing a 2.4% decrease compared to $3 billion last year.
Expenses increased year over year from $2.69 billion to $2.82 billion, and Community Health Systems CEO Tim Hingtgen attributed much of that to contract labor costs driven by the labor market and inflationary pressures.
He also pointed to lower volume, as admissions decreased 3.5% from 111,543 to 107,805 year over year, while adjusted admissions dropped by 0.5% from 248,013 to 247,119.
Hingtgen expressed optimism for a bounce back in admission volume, as well as in strategies to combat the labor issue.
"We have initiatives underway intended to actively address these pressures by accelerating strategic growth opportunities in key markets, aggressively working to recruit and retain permanent staff to replace contract labor, achieving incremental expense reductions, and leveraging our centralized resources to achieve improved results," Hingtgen said in a statement.
"Over the past several quarters, we have made strategic investments in our markets, and we continue to believe we are well-positioned to meet healthcare demand and take market share as patient volumes return. We are committed to intense operational execution, and we remain confident that our strategies will deliver long-term growth and value."
The 83-hospital system did complete the divestiture of one hospital in July, but received the proceeds at a preliminary closing for the second quarter.
The proposed rule will prohibit discrimination on the basis of race, color, national origin, sex, age, and disability in healthcare programs and activities.
The Biden administration is seeking to reinstate nondiscrimination protections for individuals under Section 1557 of the Affordable Care Act, which would strengthen civil rights limited during the Trump era.
HHS announced the proposed rule will prohibit discrimination on the basis of race, color, national origin, sex, age, and disability for certain health programs and activities. It will also interpret Medicare Part B as federal financial assistance for the first time, ensuring the protections are applied more broadly.
The 2020 version of the rule under the Trump administration limited its scope and power and rolled back nondiscrimination protections from the Obama era, specifically on gender identity and the termination of a pregnancy. It received major pushback at the time from individuals and groups, such as the American Hospital Association and the American Medical Association.
The newly proposed rule makes clear that discrimination on the basis of sex includes discrimination on the basis of pregnancy or related conditions, including pregnancy termination, HHS stated.
"Everyone in America should be able to get the care that they need from any health provider in the country, especially if that provider is receiving funding from HHS," secretary Xavier Becerra said on a call with reporters.
“We want to make sure that Americans are free from discrimination when they try to access the care that they need."
The proposed rule also addresses requirements for providers and health plans:
Clarifies the application of Section 1557 nondiscrimination requirements to health insurance issuers that receive federal financial assistance.
Requires entities to provide a notice of nondiscrimination along with an notice of the availability of language assistance services and auxiliary ads and services.
Explicitly prohibits discrimination in the use of clinical algorithms to support decision-making in covered health programs and activities.
Refines and strengthens the process for raising conscience and religious freedom objections.
Comments on the proposed rule are due 60 days after publication.
Critical access hospitals (CAHs) have not had to abide by the rule in recent years due to financial strains and COVID, but there is concern of future enforcement.
In a letter to HHS, a bipartisan group of 25 House members has asked for clarification on the enforcement of Medicare's 96-hour payment rule for CAHs after the COVID-19 public health emergency (PHE).
The members, in their written remarks to HHS secretary Xavier Becerra, conveyed the potential ramifications of the rule if it is not continued to be waived as it has during the PHE to help CAHs survive the impact of the pandemic.
Established through the Balanced Budged Act of 1997, the rule requires CAHs to certify inpatients will be discharged or transferred to another hospital within 96 hours of admission to receive payment. CAHs are also required to ensure inpatient stays are below 96 hours on an annual average basis.
After COVID surged, the rule became nearly untenable as many patients required long hospital stays. However, even before the pandemic, the members argue that the rule put CAHs in difficult positions which resulted in patients not receiving care or being forced into unnecessary transfers to other facilities, while the hospitals often had to forego payment.
"Even after the PHE formally ends, COVID and other respiratory diseases are likely to cause some patients to need hospitalizations lasting longer than 96 hours," the representatives wrote. "These and other patients who can safely and effectively be treated in their local hospital deserve the option of receiving care closer to their homes, families, and usual doctors."
Though the 96-hour rule has not been enforced in the last several years, the members express concern that the end of the PHE will mark a return.
Specifically, they seek answers to the following five questions by September 9:
Upon termination of the COVID-19 PHE, do you intend to reinstate enforcement of the 96-hour conditions of participation or payment?
What rationale was employed in determining whether the condition(s) would be enforced following the PHE?
If either condition will be enforced after the end of the PHE, will there be a grace or phase-in period before penalties will be applied to CAHs that fail to meet the condition(s)?
What impact do you believe enforcement would have on the outcomes of patients hospitalized for treatment of COVID-19, pneumonia, and other acute respiratory infections?
Do you support legislative efforts to repeal either or both of the 96-hour conditions?
With the PHE set to end on October 13, governing bodies of healthcare need to consider what a post-COVID landscape looks like and how the enforcement of a rule like the 96-hour stipulation would impact providers and patients.
The health system survived a bumpy start to the year dealing with contract labor and other expenses.
Profits were down for HCA Healthcare in the second quarter of the year as compared to Q2 of 2021, but the health system pointed to declining costs as reason for optimism for the remainder of the year.
The Nashville, Tennessee-based facility operator announced net income of $1.15 billion in its Q2 earnings report, a fall from the $1.45 billion it raked in during the same period last year.
Revenue, however, was up year over year, with $14.82 billion earned over the past three months, compared to $14.43 billion in 2021.
Meanwhile, same facility admissions declined 1.2% and same facility equivalent admissions increased 0.5% in Q2, compared to last year.
"Many aspects of our business were positive considering the challenges we faced with the labor market and other inflationary pressures on costs," said Sam Hazen, CEO of HCA Healthcare. "Our teams executed well as they have in the past through other difficult environments."
In the earnings call, HCA Healthcare leaders said operating costs were flattening from the highs during earlier stages of the COVID-19 pandemic.
Labor contracts usage, in particular, fell in Q2 and is expected to continue declining through the rest of the year, alleviating some of the expenses on the bottom line.
HCA Healthcare CFO Bill Rutherford said in the call: "[Contract labor] was at a peak high in the first quarter really due to the COVID services, and we anticipated to be able to see sequential improvement. And indeed, that's what we saw. We thought it would first start with being able to modify the rates that we were seeing in the market in terms of the average early rate. And indeed, we saw that and we were able to execute on that as the quarter went through.
"We finished with June at rates we were anticipating when we reset our guidance after quarter. And I think over the course of the year, we'll continue to see hopefully a reduction in the utilization of that contract labor."
A survey reveals only 36% of respondents have researched prices for healthcare services and when they do, it's usually not through providers.
It's payers, not providers, that most Americans turn to when seeking out pricing information for healthcare services, according to a survey on price transparency.
The poll, conducted by YouGov on behalf of AI for healthcare operations company AKASA, highlights the need for both insurers and providers to follow pricing regulations for the sake of the patient experience.
Of the 2,026 adults surveyed nationally in March, just 36% indicate they have researched prices for services, of which 60% say they would look to their insurance company for pricing information.
When seeking out information through a payer, 44% would look on the insurer's website and 29% would call their insurer.
When looking to a provider for information, 39% would visit a physician or hospital website, while 34% would call their physician or hospital. A remaining 32% would access a patient portal for prices.
However, respondents say information from payers isn't always available, with 44% answering their insurance company does not provide pricing information for local providers. Another 34% don't know if this information is available.
CMS now requires payers to disclose pricing information and comply with price transparency regulations, as of July 1. This includes providing machine-readable files containing in-network rate files for all covered items and services between the health plan and in-network provider, as well as the allowed amount file for billed charges from out-of-network providers.
Hospitals, meanwhile, have been required to follow the price transparency rule since its implementation on January 1, 2021, by providing a machine-readable file with all items and services, and a display of shoppable services in a consumer-friendly format.
Though the onus has so far mostly fell on providers to provide patients with pricing information, the survey and recent regulations show insurers must do their part.
"As the data indicates, patients are most often either turning to their insurance company or to their care provider through a variety of platforms to understand their price of care," said Ben Beadle-Ryby, co-founder of AKASA. "Clearly, both providers and payers have a critical role to play, and the healthcare industry as a whole must work together to holistically improve price transparency, which is a key piece of the puzzle to improving the overall patient financial experience."
A survey finds that organizations outsourcing their revenue cycle management are generally very satisfied with the outcomes.
Among revenue cycle leaders who manage their inpatient revenue cycle management (RCM), 22% outsource some of their outpatient or ancillary services, according to a survey conducted by the Healthcare Financial Management Association (HFMA).
The poll, done on behalf of XIFIN, gauges the interest in and opportunity to outsource outpatient RCM for more efficient processes, which has the potential to ease administrative burden and improve outcomes.
In addition to more than one in five leaders outsourcing some of their RCM, 12% of respondents want to employ this approach in the future. When they do, the survey found that organizations are generally very satisfied with the outcomes.
To gather the data, 302 HFMA members were given a 21-question online survey in 2021, with 157 sending in complete responses. Respondents varied in hospital size, from fewer than 100 employees (6%) to 10,000 or more employees (31%).
According to the responses, the top three business drivers that guide the approach to outpatient RCM are patient experience, process optimization, and revenue generation.
The most challenging aspects of RCM not currently addressed by people, processes, technology or services are denials and appeals management, prior authorization, and payor relations.
In analyzing the data, the authors of the survey note that the respondents show a significant need for more efficient and effective RCM and reporting optimization.
"There is pressure on hospital teams to effectively manage expanding outpatient sources of revenue and expenses," said Bill Voegeli, HFMA head of custom research and president of Association Insights. “Many of today's healthcare financial and RCM teams lack the necessary time, information and/or staff resources to fully understand the opportunities or implications for RCM automation beyond their electronic health record (EHR).
"Our research with XIFIN gives credence to the notion that healthcare finance professionals will benefit by staying up-to-date about ways to optimize the growing area of outpatient RCM and gives RCM executives insight into new avenues for optimization."
The insurer said in its earning call it will expand its subsidiary myNEXUS nationwide over the next six to 12 months.
Elevance Health experienced a slight dip in year over year profit for the second quarter as the company continues to diversify its offerings.
In its Q2 earnings report, the insurer announced net income of $1.65 billion for the past three months, an 8.4% decline from the $1.8 billion it profited over the same period in 2021. Revenue, meanwhile, rose 14.1%, from $33.8 billion to $38.6 billion.
Elevance Health saw strong growth in membership with 2.7 million new enrolees, a 6.1% rise from the second quarter of last year, to bring the total to 47.1 million members. Much of that was due to the 1.6 million new enrolees in the government business, spurred by growth in Medicaid.
During the company's earnings call, the insurer also stated its plans for subsidiary myNEXUS, a recently launched post-acute care program for Medicare members in Indiana. Elevance Health president and CEO Gail Boudreaux said the plan is to expand the program nationwide over the next six to 12 months, which will help optimize levels of care post inpatient discharge, improve the patient-provider experience, and grow Carelon, the company's healthcare services brand subsidiary.
The insurer displayed its commitment to diversifying when it changed its name earlier this year from Anthem to better reflect their goal of offering a wide range of health-related services.
"The disciplined execution of our strategy, and the balance and resilience of our diversified portfolio of businesses has enabled us to deliver another quarter of strong organic growth, and we have raised our outlook for 2022 earnings per share as a result," said Boudreaux.
"Our recent name change to Elevance Health and the broader rebranding strategy underscores our transformation to a lifetime, trusted health partner and our diversified set of businesses that lend resilience in any business environment. We are uniquely well-positioned for growth in the future as we remain focused on meeting the needs of our clients and customers."
