- The strategic agenda facing hospital and health system
- leaders right now is not a short list.
- Growth in a consolidating market, sustainable margins in
- a reimbursement environment that rarely moves in your
- favor,
- a tech investment cycle that demands both urgency
- and discipline,
- and a workforce story that is still being
- written.
- Eker's fourteenth annual CEO CFO roundtable brings together
- more than 1,500 executive level attendees and nearly
- 400 speakers across four days of sessions that
- are designed to help c suite leaders benchmark,
- pressure test, and sharpen their priorities.
- Not in the abstract, but against the real
- decisions they'll face heading into the next year.
- It's the kind of event you leave with
- a clear sense of where you stand and
- what comes next.
- So join us November second through the fifth
- at the Hyatt Regency in Chicago,
- and come ready to do the hard thinking.
- Register on our events page at beckershospitalreview.com
- by clicking on the events tab in the
- upper right.
- This is Scott Becker with the Becker's Healthcare
- podcast.
- We're joined today by Laura Dirda. Laura is
- the editor in chief at Becker's Healthcare.
- She joins us regularly to talk to us
- about issues that she's watching in health care
- and and what's top of mind.
- Laura, let me turn it to you and
- ask you what are a couple of the
- issues that you're watching. And at some point,
- for people that don't listen regularly, you might
- not know this, but Laura is a huge
- Chicago White Sox fan. And the Chicago White
- Sox have had the biggest turnaround in Major
- League Baseball. They three one hundred lost seasons
- in a row. This year, they're winning the
- division. So at the very end of the
- call, I'll ask Laura also for assessment about
- the White Sox and where they're going this
- year. Laura, let me teed up and start
- with health care. What are you watching closely
- currently?
- Absolutely. Well, thank you so much, Scott. And,
- yes, there are many stories we're watching very
- closely both on the health care as well
- as White Sox side. But, you know, one
- of the things that, we have been reporting
- on and will continue to do is some
- updates on CMS payment schedules.
- In the last couple days, CMS has finalized
- its fiscal twenty twenty seven inpatient payment rule,
- and there's a lot for hospitals and health
- systems to unpack. I think first, when you
- look at the money, hospitals are getting a
- 2.3%
- pay increase, which is just under what CMS
- proposed back in April. And the total inpatient
- payment rises is about 2,100,000,000
- along with new technology add on payments jumping
- to around $779,000,000.
- So not quite as much as hospitals were
- expecting to look at the increase, but, also,
- you know, a lot of other factors are
- playing into how hospitals and health systems are
- thinking about pay for next year. And one
- of those things in in perhaps the bigger
- story coming out of new payment rules is
- the mandatory bundled payments.
- CMS finalized its CJRx, which is the first
- mandatory nationwide
- episode based payment model covering hip, knee, and
- ankle replacements.
- And now we'll start on 01/01/2028.
- That is pushing it back a quarter from
- its original start date.
- Most of the inpatient
- payment system hospitals will be on the hook
- for spending across the surgery, hospitalization,
- the first ninety days of recovery
- within those bundles, and that's something that at
- hospitals,
- some have been doing for a while as
- they participate in these programs, but most haven't
- really consistently
- seen a huge, huge value from doing that
- or or been doing that for all patients.
- So,
- it'll be a big change for hospitals we're
- looking at, especially, orthopedic procedures that are more
- high revenue, high dollar procedures.
- The has already pushing back on this saying
- the low volume threshold doesn't really give hospitals
- enough cases to actually manage outcomes
- way that they might need to. So,
- there's something that is really important for hospitals
- across the board to be thinking about and
- looking at. And then
- another element that is thrown in there too
- is,
- special payments for rural and small hospitals will
- expire 12/31/2026,
- the last congress acts. And so,
- for these small hospitals and rural hospitals that
- have been depending on, some of these funding
- sources,
- you know, they're really, really advocating strongly for
- those to continue
- as many are facing additional financial challenges and
- constraints as they're trying to serve their communities.
- And even the the large,
- regional and and academic centers are hoping that
- these continue as, you know, if hospitals close
- those,
- hospitals and systems in in the,
- regional larger hubs will have to figure out
- how they're gonna accommodate to provide care for
- those patients,
- within the rural communities and small hospitals. So
- those institutions play a really important role in
- the broader health care ecosystem that it'll be
- important for them to continue to stay funded
- in a meaningful way and,
- looking at how they can, continue their operations
- and provide services for their communities.
- And then finally, when we're looking at quality
- measures, CMS said it will hold Medicare Advantage
- data into the mortality and readmission measures and
- adding some new substance readmission measures that will
- start affecting,
- payment in the 2030 fiscal year.
- And and so hospitals and systems,
- as they're
- making sure they understand what those quality metrics
- are, we'll have to deliver on them and
- and just be very, very sharp with especially
- the new sepsis readmissions measures so that their
- payment isn't impacted,
- in in a few years.
- Thank you very, very much. And what are
- hospitals saying about the increase, the 2.3%
- increase,
- happy, unhappy? What does that look like?
- Yeah. Yeah. Yeah. I mean, I I think,
- you know, by and large, hospitals and health
- systems for sure want,
- you know, are in kind of a a
- financially strapped situation in many ways. So,
- you know, I think they wish that the
- increase was more and think that the value
- that they provide,
- should be
- rewarded as such. I think many of the
- payments have been
- flat or or, you know, not really keeping
- up with what inflation has been, what it
- it's taking to spend on the workforce and
- supplies and everything else, the technology that is
- required to provide,
- high quality health care today. And so,
- putting them into a bit more of a
- a pinch than they would like to see
- with these Medicare payments. And, of course, in
- many ways, the, commercial insurers are
- basing their payments off of what Medicare is
- doing. And so more often than not, we
- see people really wanting and advocating for those
- deeper increases
- in more recognition of what they're doing in
- order to provide care for their communities and
- assuming responsibility
- for the patients at large.
- Thank you. No. Fasting to watch. I know
- we're still in a spot where 60% of
- hospitals are in the black, 40% are in
- the red.
- So still plenty around there approximately.
- So so plenty of challenges being faced by
- health systems and reimbursement.
- Anything else you're watching,
- that we didn't cover yet?
- Yeah. Yeah. Well, along these same lines, I
- think the other big report that came out
- on August 3 was looking at,
- ACA marketplace insurers.
- Those insurers are proposing a a median rate
- increase of 15%
- for 2027,
- and that's the second straight year of double
- digit hikes, according to a Peterson Kaiser Family
- Foundation health system tracker report.
- Some of those key drivers on the medical
- side are that insurers,
- point to about a 10%
- median medical trend
- increase for, 2027,
- citing in the inflation, labor shortages,
- claim severity, then also thinking about GLP one
- drugs and and demand usage there, provide our
- consolidation as well as disputes around the no
- surprises act between
- patients and, or, excuse me, between health care
- providers and insurers.
- But the policy
- is
- actually doing a lot of work here too.
- Insurance companies flagged that
- expiration of the enhanced premium tax credits is
- one factor that is,
- boosting rates because it,
- it is shrinking the risk pool and and,
- healthier people are still the ones most likely
- to drop coverage when subsidies shrink. And so
- that's leaving insurers with sicker and and costlier
- pool of patients.
- And then after the subsidy premium payments already
- rose 58% on average this year, and so
- looking at more next year, will be particularly
- challenging for a lot of those patients that
- really need that health insurance.
- And then regulatory changes in along with HR
- one,
- that will go into effect next year are
- cited as factors as well within some of
- these challenges.
- And then proposed changes for 2027, the range
- from about a 1% decrease to around 54%
- increase,
- with most insurers landing between a 10 to
- 25%
- increase. And that's really important for,
- all in health care to understand. Obviously,
- as the insurance becomes more expensive on the
- marketplace, it is possible that,
- there'll be fewer people that decide to purchase
- it, and go that route. There may be
- more uninsured patients, more uncompensated
- care, and hospitals and systems are preparing for
- that reality, not only for those who may
- not be eligible for Medicaid next year,
- but also for these folks too who may
- decide not to repurchase or or purchase through
- the ACA marketplace because,
- the insurance increases are are too high. So,
- it's definitely gonna be an interesting landscape towards
- the end of the year as we look
- at insurance coverage, and,
- executive teams have the work cut out for
- them to make sure there's access to care
- and and understand what they're gonna need in
- order to be ready for additional,
- uncompensated
- care and uninsured patients.
- Thank you. And you do see sort of
- some
- slight reduction in total number of people in
- Medicare Advantage
- or or the percentage.
- Is that accurate?
- Yeah. I
- that that's been what, you know, we we've
- seen from the reporting, when you're looking at
- Medicare Advantage. I think, obviously,
- it differs based on, which aspects of Medicare
- Advantage you're looking at. But, you know, I
- think it is obviously heavily marketed to patients
- and something that,
- you know, on the starkness of it seems
- like it provides a lot of benefits. But
- as many health care providers know on the
- back end, it can be just such a
- challenge
- to administer and,
- may not always provide the benefits that,
- these Medicare Advantage Plans,
- in the same way that say they do.
- I think we've heard,
- just about a good number of denials coming
- through some of these plans. And so, you
- know, as,
- patients and and,
- beneficiaries and members
- have that experience, they may decide to do
- something different, or we may see, continued increases
- in the Medicare Advantage Plans just because of
- how
- much they've been able to kind of integrate
- themselves within,
- the Medicare beneficiary population.
- No. Thank you so much. And it does
- seem like you you are seeing some more
- insurers exit some Medicare Advantage markets
- and also some health systems exit their contracts
- with Medicare Advantage payers, but fasting to watch
- a sort of tipsy topsy, you know, up
- and down of the Medicare Advantage market and
- where that's going. Wow.
- But, Laura, as always, I I wanna thank
- you so much for joining us today on
- the Beckers HealthCare podcast. I always learn something.
- Thank you for joining us. You do a
- fantastic job. Thank you very, very much. Absolutely.
- Thank you, Scott. It's always a pleasure.