News

More than 46 million prior authorization requests were submitted to Medicare Advantage insurers in 2022, according to KFF analysis released Aug. 6 examining data submitted by MA insurers to the Centers for Medicare & Medicaid Services on prior authorization requests, denials and appeals from 2019 through 2022.

Darryl A. Elmouchi, M.D., chief operating officer of Corewell Health, discusses the current constraints facing caregivers when managing their day-to-day responsibilities, and how Corewell piloted innovative programs to help their employees get back to the main priority of patient care.

The 5th Circuit Court of Appeals Aug. 2 affirmed a district court's decision to set aside certain regulations implementing the No Surprises Act. In particular, the decision invalidates regulatory provisions governing how arbitrators are to weigh the qualifying payment amount in arbitration proceedings.  

John Riggi, AHA national advisor for cybersecurity and risk, explains why cybercriminals are shifting from directly targeting hospitals to hitting the third-party technology and service providers critical to supporting hospitals’ clinical care. He highlights four key strategies to help hospitals and health systems strengthen their third-party risk management program against the debilitating effects of the next, inevitable Change Healthcare-like cyberattack.

At the AHA Leadership Summit in July, I had the honor of presenting the 2024 AHA Quest for Quality Prize to WellSpan Health and also recognizing Carilion Clinic, Jefferson Health and MUSC Health as finalists.

The AHA along with the Association for the Health Care Environment recently released the Environmental Services Competency Resource Search Catalog, which provides EVS professionals with resources needed to build or enhance their skills and advance their careers while working to reduce the spread of infection in health care settings.

In an op-ed published Aug. 2 in the Pittsburgh Post-Gazette, former Pennsylvania Governor Tom Corbett highlights how hospitals, especially those in rural areas, are facing significant financial challenges and how some proposals being considered by Congress would cut patient care by slashing billions of dollars in funding to hospitals.

Despite the diligent efforts of hospitals, health systems and medical professionals to prevent violence, health care workers remain five times more likely than any other type of worker to be physically attacked on the job.

UnitedHealth Group Aug. 1 announced the creation of a gold card program for qualified practices. Under the program, the practices that earn gold card status will not be required to submit prior authorization requests for certain medical, behavioral and mental health services.

A Commonwealth Fund report published Aug. 1 examines how frequently insured, working-age adults are denied care by insurers; how often they are billed for services they believed were covered; and their experiences challenging such bills or care denials. The report shows that 45% of insured, working-age adults reported receiving a medical bill or being charged a copayment in the past year for a service they thought should have been free or covered by their insurance.

OneBlood, a nonprofit organization that provides blood and blood products to health care providers in Florida, Georgia, Alabama, North Carolina and South Carolina, including more than 350 hospitals, July 31 said it is experiencing a ransomware event that is impacting its software system and disrupting some of its operations to deliver blood. 

The Senate Appropriations Committee Aug. 1 voted 25-3 to approve legislation that would provide $231.3 billion in funding for the departments of Labor, Health and Human Services, and Education in fiscal year 2025.

The Centers for Medicare & Medicaid Services Aug. 1 finalized policy changes to the long-term care hospital standard rate payment system that will increase payments by 2.0%, or $45 million, in fiscal year 2025 relative to FY 2024.

The Centers for Medicare & Medicaid Services Aug. 1 issued a final rule that will increase Medicare inpatient prospective payment system rates by a net 2.9% in fiscal year 2025, compared with FY 2024, for hospitals that are meaningful users of electronic health records and submit quality measure data.

The Centers for Medicare & Medicaid Services July 31 issued the final rule for the inpatient psychiatric facility prospective payment system for fiscal year 2025.

The Centers for Medicare & Medicaid Services July 31 released the fiscal year 2025 final rule for inpatient rehabilitation facilities, which will update IRF payments by an estimated 3% overall (or $300 million) in FY 2025.

The Centers for Medicare & Medicaid Services July 31 issued a final rule for fiscal year 2025 for the skilled nursing facility prospective payment system, which will increase aggregate Medicare spending by 4.2% or $1.4 billion compared to FY 2024.

In a new "Safety Speaks" conversation, Jamie Orlikoff, president of Orlikoff & Associates, Inc. and AHA national adviser on governance and leadership, discusses the role hospital boards can play in supporting quality and safety within their health systems, and how board members who aren't clinicians or health care administrators can make a difference in patient safety.

Mary Thompson — a member of AHA’s Committee on Behavioral Health and president of Trillium Place, a mental health and addiction recovery organization affiliated with Carle Health — explains how the Illinois-based organization works to integrate physical and behavioral health services to improve access to care among historically underrepresented communities and eliminate health disparities.

The Centers for Medicare & Medicaid Services July 31 updated the Overall Hospital Quality Star Ratings at its Care Compare website and Provider Data Catalog.