Tag: Reimbursement

Renewed push for healthcare price transparency faces familiar challenges

Editor's Note Although a recent executive order from President Donald Trump aims to make hospitals and insurers reveal negotiated prices, data inconsistencies and a lack of consumer usability continue to hinder progress, according to a March 31 article from NPR. As detailed in the report, the executive order builds on…

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By: Matt Danford
March 31, 2025
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Cardiology efficiency, orthopedic revenue surge as ASCs navigate growing complexity

Editor's Note HST Pathways’ most recent industry report, discussed on the Advancing Surgical Care Podcast by HST CEO David Thawley and Bill Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), offers insights into cardiology and orthopedic procedures done in ambulatory surgery centers (ASCs) in 2024, Ambulatory Surgery Center News…

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By: Tarsilla Moura
March 26, 2025
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Hospital closures rise in 2025 amid ongoing financial pressures

Editor's Note Ten hospitals have reportedly closed 3 months into the year, with five shuttering in February alone—a stark escalation compared to the 25 closures reported in 2024 and 14 in 2023, Becker’s Hospital Review March 21 reports. This troubling trend raises questions about the mounting difficulties hospitals face, from…

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By: Tarsilla Moura
March 25, 2025
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Study: CMS sepsis care protocol shows no clear mortality benefit

Editor's Note A systematic review found no strong evidence that compliance with the CMS Severe Sepsis and Septic Shock Management Bundle (SEP-1) reduces mortality, raising questions about its inclusion in hospital performance measures, according to a February 19 report from the University of Minnesota’s Center for Infectious Disease Research and…

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By: Matt Danford
March 12, 2025
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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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