Article
Top healthcare concerns: Prepare for reimbursement and transaction constraints
March 3, 2024 · Authored by Chris Pritchard
A version of this article was published in the March edition of Healthcare News.
As the rapidly shifting healthcare landscape brings mounting regulations, financial pressures, and other challenges, reimbursement and antitrust emerged as priorities for leaders to address during the 2023 Executive Healthcare Conference.
Reimbursement complexities are making it more challenging for providers to achieve financial sustainability, while regulator-driven merger controls meant to soften mega-transactions could impact what deals are approved and how transactions are executed.
Prepared organizations can navigate these challenges, capitalize on opportunities, and create more resiliency in business plans with interdepartmental alignment between teams such as compliance, legal, revenue cycle, and patient experience. Prioritize the following challenges in the healthcare landscape in 2024 to help your organization stay ahead of change and manage their impact.
Future of reimbursement
Government reimbursement continues to be in a perilous state, with hospitals averaging 82 cents to the dollar for care of Medicare patients and less for Medicaid patients. In turn, the financial squeeze has pushed many private practitioners into health system partnerships.
Site neutral payments
As providers contend with those preexisting pressures, they also see other concerns ahead. After a landmark 2015 modification and additional exceptions, there’s increasing focus on site-neutral payments. While government reimbursement continues to expand on minimizing or eliminating payment variation based on site-of-service, many providers say it doesn’t account for the nuances in care delivery.
Lawmakers have yet to review potential changes as part of several proposed policies. In the meantime, healthcare leaders are right to keep their eye on site neutrality in 2024 and beyond.
“We’re talking about moving reimbursement to equalize sites and ignoring any additional resource usages that are necessary in one versus the other,” the firm's moderator said. “It's probably going to continue to be tough to determine what services should be performed in these different environments.”
