Costs & Cost Controls

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March 2025
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Simple procedure or ‘surgery’? Questionable medical billing practices cause confusion

Editor's Note Certain medical bills reclassifying minor procedures as “surgery” are driving up costs and causing confusion among patients, KFF Health News December 13 reports. Cases such as a $414 charge for a splinter removal with tweezers and a $469 charge for freezing a skin tag highlight how CPT codes…

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By: Tarsilla Moura
December 18, 2024
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Antitrust guideline withdrawal could dampen M&A, boost uncertainty for provider joint ventures

Editor's Note In a move that could hinder provider-led joint ventures and increase regulatory uncertainty, the Federal Trade Commission (FTC) and the Justice Department have withdrawn antitrust guidance issued in 2000. Modern Healthcare reported the news on December 16. Passed in a 3-2 vote, the decision eliminates previously relied-upon safe…

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By: Matt Danford
December 18, 2024
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Fitch Ratings: Hospital credit outlook improves amid stabilizing margins

Editor's Note The credit outlook for the nonprofit hospital sector improved from “deteriorating” to “neutral” in Fitch Ratings’ 2025 report, the first revision in more than 2 years. Healthcare Dive reported the news December 11.  According to the outlet, Fitch attributes the shift to “steady improvement” in hospital operating margins,…

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By: Matt Danford
December 17, 2024
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US obesity rates decline for first time in a decade

Editor's Note An analysis of trends in body mass index (BMI) and obesity among US adults from 2013 to 2023 reveals a slight but significant decline in obesity prevalence in 2023, marking the first decrease after years of steady increases. The findings are detailed in a December 13 JAMA Health…

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By: Matt Danford
December 16, 2024
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Costs drop, access expands for GLP-1 weight loss drugs

Editor's Note Access to GLP-1 medications is improving as manufacturers, insurers, and policymakers address high demand, costs, and coverage challenges, Becker’s Hospital Review reported December 13. As detailed in the article, Eli Lilly’s partnership with telehealth company Ro now allows patients to obtain Zepbound prescriptions online and receive shipments directly…

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By: Matt Danford
December 13, 2024
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Anthem anesthesia payment policy reversal prompts statement from American Society of Anesthesiologists

Editor's Note The American Society of Anesthesiologists (ASA) commended Anthem's reversal of a policy to deny anesthesia payment based on arbitrary time limits, which was set for February 2025 in three states. “The now-rescinded policy was inconsistent with prevailing standards, regulations and billing norms, and revealed a diminished dedication to…

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By: Matt Danford
December 6, 2024
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Study: AI improves surgical case length predictions

Editor's Note A recent study developed and validated an artificial intelligence (AI) model leveraging natural language processing (NLP) and machine learning to significantly improve prediction accuracy for surgical case length. Published November 29 in the journal Surgery, the findings show promise for using AI as an alternative to current methods…

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By: Matt Danford
December 4, 2024
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Study: Rural hospital mergers, acquisitions boost financial stability, care access

Editor's Note Data show nearly half of rural hospitals categorized as high-risk financially improved their stability after mergers, acquisitions, or affiliations (M&A) with larger health systems, Fierce Healthcare reported December 2. Conducted by Dobson DaVanzo & Associates and commissioned by the Coalition to Strengthen America’s Healthcare, the analysis found that 110…

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By: Matt Danford
December 4, 2024
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Save the date for the 2025 OR Business Management Conference

Editor's Note Curious to learn how hurricane-impacted health organizations are navigating supply chain challenges? What about the latest trends in ambulatory surgery centers (ASCs), AI-driven scheduling software, or the workings of the hospital C-suite? Designed specifically for perioperative business leaders seeking to optimize efficiency and increase profitability, the 2025 OR…

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By: Matt Danford
November 22, 2024
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Hospital financial report predicts stability, high cybersecurity costs for 2025

Editor's Note Hospitals’ financial outlook is stable, although growth is slowing and certain costs are projected to increase, particularly for cybersecurity, according to two recent Becker’s reports on data from Moody’s Investor Services. The first, published November 14 in Becker’s Hospital CFO Report, notes that “hospitals are facing a stable…

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By: Matt Danford
November 20, 2024
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