Congress is actively considering several bills related to site-neutral payment that has hospitals across the U.S. significantly concerned. The proposed legislation would lower the price that Medicare pays hospitals for common outpatient services, such as x-rays and general checkups, and match what it pays outpatient facilities such as physician offices. Facilities that are owned by hospitals (known as hospital outpatient departments, or HOPDs) earn more than twice what an independent outpatient facility earns for providing the same services. This Health Capital Topics article will review the changes that are being considered by Congress, as well as the responses from stakeholders. (Read more...)

After being in place for over three years – and after 1.1 million deaths and 6 million hospitalizations in the U.S. – the COVID-19 public health emergency (PHE) finally ended on May 11, 2023. The PHE, which was originally declared by the Secretary of Health and Human Services (HHS) on January 31, 2020, granted the federal government temporary powers to help alleviate the effects of the pandemic, particularly in the healthcare sector. During the PHE, the federal government also took action to cushion the effect of the pandemic on providers, supporting public health efforts and stimulating the economy with investments of $4.4 million through multiple legislative packages and the enactment of over 200 regulatory waivers. (Read more...)

On April 26, 2023, the California-based healthcare giant Kaiser Permanente announced a $5 billion “mega deal” to acquire Pennsylvania health system Geisinger Health. Kaiser also announced the formation of a new nonprofit health system, to be called Risant Health. Geisinger Health will be the first health system under the umbrella of Risant Health, although Kaiser aims to add approximately five more systems to the entity. This Health Capital Topics article will review this mega deal and discuss what this transaction may mean for hospitals and health systems. (Read more...) 

Healthcare provider organizations, including Medicare Advantage organizations (MAOs), face a range of federal and state legal and regulatory constraints, which affect their formation, operation, procedural coding and billing, and transactions. This final installment of the three-part series on the valuation of Medicare Advantage (MA) plans will review the regulatory environment in which these plans operate. (Read more...)