Wolfe | Pincavage

Payer-provider relationships continue to go downhill. A new report from Healthcare Financial Management Association (HFMA) shows what many of us already suspected: things between providers and payers are worsening. Nearly 60% of health system CFOs say their relationships with health plans have worsened in the past three years and 80% believe payers are deliberately increasing denials! But there's a solution. Increased transparency from payers could be the key to fixing these fractured relationships. Interestingly, most providers aren't banking on AI to solve the problem just yet. Check out the article here:

As the new administration makes way to take office, significant policy changes are expected to impact the healthcare landscape—especially for pharmaceutical, medical device, and digital health companies. With potential shifts in regulations, compliance, and strategic priorities, it’s critical for stakeholders to stay informed. Read the full The Wall Street Journal perspective here.

Medicare cuts are hurting patients and doctors. The American Medical Association is urgently calling for reform to the Medicare payment system, which has seen a 29% drop in physician pay since 2001. This crisis is hitting rural communities hardest. Join the AMA's Fix Medicare Now campaign and tell Congress to take action!

Both U.S. presidential candidates highlighted the urgent need for accessible home care for seniors. Expanding Medicare to cover home care and "at-home Senior Care" emerged as key policy proposals to address growing disparities. Modern Healthcare delves into the challenges and communities most affected by limited access to home care, especially in rural areas grappling with provider shortages and potential Medicare cuts. Read more here:

The 2024 Atlantic hurricane season has left a devastating financial toll, particularly on healthcare systems in the Southeastern U.S. According to Fierce Healthcare, HCA Healthcare expects expenses and revenue loss between $200 and $300 million in Q4 due to Hurricanes Helene and Milton. The article highlights the challenges faced, from facility damage and supply chain disruptions to evacuations and increased demand for emergency care.

"Creativity is intelligence having fun" We are pleased to announce our firm website won a Silver Davey Award. The Daveys are an annual competition recognizing outstanding creative work from small agencies, in-house teams, and independent creators. The awards are named after the story of David defeating Goliath with a big idea and a little rock. A round of applause to our digital marketing agency, Doodle + Code! Take a look at our new, award-winning website: https://lnkd.in/e7a6iZUS

A recent Healthcare Financial Management Association (HFMA) article, highlights the challenges faced by providers as Medicare Advantage (MA) plans increasingly categorize hospital visits as outpatient observation stays, even when patients require extended care. According to the article, "...MA plans categorized hospital visits as outpatient observation stays at a rate over three times as high as traditional Medicare." This practice raises concerns about the appropriate application of the Two-Midnight Rule and the potential for underpayment to providers. At Wolfe Pincavage, we have extensive experience advising healthcare clients on the Two-Midnight Rule. We can help you understand your rights and obligations. https://bit.ly/4f1plUv cc: Becky Greenfield, JD, MPH

Happy Halloween from our team at Wolfe Pincavage!

UnitedHealth Group, Humana, and CVS Health are denying roughly 25% of requests for post-acute care from their Medicare Advantage enrollees, according to a new Senate investigation. The report suggests these insurers are using sophisticated technologies to target denials for services like nursing home care and inpatient rehabilitation. cc: STAT

Level up your provider/payer relations skills with this Florida Chapter HFMA event! Register now: