Archive for hospitals


Hospitals Starting to Comply With Price Transparency Requirement

One out of every three hospitals is in full compliance with a federal mandate to post payer rates publicly and transparently.

And many others are partially in compliance with the federal requirement that took effect on January .

Full compliance requires that the postings are machine-readable and include payer-negotiated rates for 300 “shoppable services.”  2000 of 6000 hospitals are already meeting four of five federal criteria and about 20 percent appear to be on their way to doing so.

Hospitals began working to comply with the new federal mandate when their attempt to block it in court failed.

Learn more about how hospitals are responding to the mandate to move toward price transparency in the Fierce Healthcare article “Analysis:  Roughly 2,000 hospitals fully compliant with new price transparency rule.”


Oregon Establishes Community Benefit Levels for Hospitals

Individual hospitals will need to meet specific community benefit requirements to retain their non-profit status under a new program in the state of Oregon.

As described in a news release from the Oregon Health Authority and Department of Human Services,

Each tax-exempt hospital or hospital system in the state will receive a floor for community benefit spending based on their revenues, prior expenditures, financial health, and the needs of the population served. 

As part of the program,

The bill created new standards for financial assistance to patients including increasing the income thresholds for charity care, limited medical debt collection and interest, instituted new data reporting requirements, and introduced a new community benefit minimum spending floor program.

Learn more about Oregon’s attempt to require hospitals to prove their worthiness for their non-profit status from this news release from the state’s Department of Human Services and the Oregon Health Authority and a document explaining the state’s methodology for calculating individual  hospitals’ community benefit requirements.…

Financial Outlook Weak as Non-Profit Hospitals Face Challenging 2021

Non-profit hospitals face numerous challenges to their financial health in 2021, according to a recent analysis by Moody’s, the bond-rating company.

Among those challenges are weak cash flow caused by reduced non-urgent procedures; weak demand; a shift of patients to lower-cost, lower-revenue outpatient settings; changes in payer mix as Medicaid enrollment continues to rise and more patients lose their health insurance; and COVID-19-related expenses that continue to drive up costs.

Learn more about Moody’s outlook for non-profit hospitals in 2021 in the Fierce Healthcare article “Moody’s:  Not-for-profit hospitals face major cash constraints, negative outlook for 2021.”…

GAO Calls for More Work Scrutinizing Hospitals’ Tax-Exempt Status

The question of whether non-profit hospitals are doing enough to justify their tax-exempt status is the focus of a new Government Accountability Office study on the manner in which the Internal Revenue Service evaluates hospitals’ tax exemption.

According to the study, the IRS struggles with one of the three primary criteria for non-profit hospitals’ tax-exempt status outlined in the Affordable Care Act (PPACA):  whether the community benefit such hospitals provide justifies their tax exemption.

The GAO review observed that

While PPACA established requirements to better ensure hospitals are serving their communities, the law is unclear about what community benefit activities hospitals should be engaged in to justify their tax exemption.  The Internal Revenue Service (IRS) identified factors that can demonstrate community benefits, but they are not requirements.  IRS does not have authority to specify activities hospitals must undertake and makes determinations based on facts and circumstances.  This lack of clarity makes IRS’s oversight challenging. Congress could help by adding specificity to the Internal Revenue Code (IRC).

The GAO report also notes that

…according to IRS officials, hospitals with little to no community benefit expenses would indicate potential noncompliance.  However, IRS was unable to provide evidence that it conducts reviews related

CMS Finalizes FY 2021 Payments to Hospitals

Medicare has announced how it will pay hospitals for inpatient care in FY 2021 with publication of its annual inpatient prospective payment system regulation last week.

Among the changes announced by the Centers for Medicare & Medicaid Services:

  • A 2.9 percent increase in fee-for-service inpatient rates.
  • A compromise on its proposal to require hospitals to report their payer-specific negotiated rates with Medicare Advantage plans.
  • Changes in how Medicare will calculate Medicare disproportionate share (Medicare DSH) uncompensated care payments.
  • A much smaller cut than originally proposed in the pool of funds for Medicare DSH uncompensated care payments.
  • Minor adjustments in the Medicare area wage index system.
  • Refinements in the Medicare graduate medical education program.
  • A new DRG for CAR T-cell payments and a new pathway to Medicare add-on payments for FDA-approved antimicrobial products.

Learn more from CMS’s fact sheet or see the final regulation itself.…