Tag: Reimbursement

Session: Riding the Wave—Considerations to Making Anesthesia Profitable in Today's Labor Market

Editor's Note The OR Business Management Conference this year for the first time offered a lineup of sessions that was fully dedicated to content relevant to ambulatory surgery centers (ASCs). In this session, Collin Pick, MSN, CRNA, ARNP, CMPE, chief of anesthesia, Physician Partners of America, explored the ongoing anesthesia…

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By: Tarsilla Moura
February 19, 2025
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CABG, TAVR drive hospital revenue despite cost variations

Editor's Note Coronary artery bypass graft (CABG) surgery and transcatheter aortic valve replacement (TAVR) generate the highest overall financial returns for US hospitals, despite not being the most profitable per procedure, according to a February 13 report in Cardiovascular Business. The article covers an analysis of Medicare data, published in…

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By: Matt Danford
February 14, 2025
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Session: Course Correction—Negotiating Payor Rates in the ASC Setting

Editor's Note Negotiating pay rates in the ambulatory surgery center (ASC) setting is a complex and evolving process that requires strategic planning, data-driven decision-making, and strong payer relationships, noted the speakers Amy Coletti, principal, ASC practice, and Matt Kilton, partner, at ECG Management Consultants at this year’s OR Business Management…

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By: Tarsilla Moura
February 12, 2025
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Opening Keynote: Charting Your Course to Success—Financial Wins through Value-Based Performance

Editor's Note Although the central tenets of value-based healthcare have not changed, in many cases implementation has been reduced to little more than reducing costs, to the detriment of clinicians and patients. In a session at the 2025 OR Business Management Conference in February, economist Susanna Gallani, PhD, examined this…

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By: Matt Danford
February 10, 2025
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Moody’s downgrades health insurance outlook as medical costs surge

Editor's Note Moody’s Ratings has shifted the health insurance industry’s credit outlook from stable to negative, according to a February 3 article in Fierce Healthcare. According to the article, the downgrade is due to escalating medical costs that outpace reimbursement rates. Analysts project an 8% rise in commercial market spending…

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By: Matt Danford
February 5, 2025
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Cigna ties executive pay to patient experience

Editor's Note As part of a larger initiative to ease access to care, insurance giant Cigna is tying compensation for senior leadership directly to customer satisfaction. Modern Healthcare reported the news February 3. The shift is part of a multi-pronged approach that also includes overhauling prior authorization requirements and limiting…

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By: Matt Danford
February 4, 2025
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Healing healthcare: How clinician incentives can help get from volume to value

Takeaways • Although the central tenets of value-based healthcare have not changed, in many cases implementation has been reduced to little more than reducing costs, to the detriment of clinicians and patients. • The right incentives, such as recognition and work support, can effectively inspire clinicians to deliver high value…

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By: Carina Stanton
January 31, 2025
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Commentary: Studies show how surgeon decisions follow the money

Editor's Note Financial incentives can shape surgeons’ decision-making, but their effectiveness depends on the structure of the payment model. This is the central message of a January 26 article in Forbes reporting on two studies: one linking a sharp increase in hernia cases to a simple Medicare coding change, and…

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By: Matt Danford
January 30, 2025
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Health system leader survey respondents brace for 2025 shifts

Editor's Note Health system leaders expect to face mounting physician challenges, shifting reimbursement models, and new growth opportunities throughout this year, according to VMG Health’s Health System Leader Expectations survey. Based on responses from 73 health system leaders, the report highlights the sector’s key trends and priorities for 2025. Key…

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By: Matt Danford
January 27, 2025
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Providers push back on insurance cost-cutting hurdles

Editor's Note Escalating administrative hurdles from insurers are heightening tensions between healthcare payers and providers who criticize the measures for threatening patient care, Modern Healthcare reported January 22. According to the article, policies attracting criticism include stringent prior authorization rules, claims denials, and new fees for appeals. For their part,…

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By: Matt Danford
January 23, 2025
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