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Medicare Advantage reimbursement fights between hospitals and insurers has contributed to a dizzying and ever-changing environment for older adults to navigate each enrollment period. Now, that environment is experiencing more upheaval as the nation’s largest insurers pull back from Medicare Advantage markets to protect profit margins amid new federal cost-containment measures and rising medical expenses. This retrenchment is not entirely new, with some regional and mid-sized health plans scaling back their MA offerings for 2025 coverage.
Hospital industry lobbyists are focusing their efforts this month on a handful of financial assistance programs and regulatory flexibilities as Congress works to keep the government open into the next fiscal year. Twelve appropriation bills or a temporary continuing resolution must be passed before Oct. 1, with some, such as the budget for the Department of Health and Human Services, having direct impacts on healthcare.
Last week, the U.S. Department of Health and Human Services (HHS) announced that Secretary Robert F. Kennedy, Jr. has directed HHS to boost resources dedicated to stopping the practice of information blocking. HHS will actively enforce measures against healthcare entities that hinder patients’ engagement in their care by blocking access, exchange, and use of electronic health information, the press release stated.
Hospital CEOs are asking their CIOs for more than technical promises before approving large-scale EHR or AI projects. Executives want evidence of measurable impact on strategy, finances, workforce satisfaction and patient care. Sustainability and mission alignment are also top priorities for hospital leaders.
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