Managed Care Contracting Is Now a Margin Test

Health Policy and Economics

Managed Care Contracting Is a Margin Test

Managed care contracting now determines far more than a rate sheet. For post-acute and senior living leaders, it is a test of margin, access, and control….
Medicare Overpayment Demands Are a Strategic Risk

Health Policy and Economics

Medicare Overpayment Demands and Risk

Medicare overpayment demands can expose weak controls, strain cash flow, and invite scrutiny. Providers need a disciplined response before recoupment begins….
CMS Changes to SNF Quality Measure Thresholds

Policy and Politics - Federal

CMS Changes to SNF Quality Measure Thresholds

CMS changes SNF quality measure thresholds can reshape ratings, reimbursement risk, and survey exposure. Operators need to know what will move and why….
Medicare Advantage vs Traditional Medicare

Health Policy and Economics

Medicare Advantage vs Traditional Medicare

Medicare Advantage vs traditional Medicare is no longer a beneficiary-choice discussion alone. It is a market-structure issue affecting referral patterns, hospital utilization, post-acute length of stay, network access, risk-bearing arrangements, and the financial viability of…

Health Policy and Economics

The Future of Healthcare Reimbursement Models

For years, healthcare operators have heard the same directive: move from volume to value. The future of healthcare reimbursement models, however, will not be settled by a slogan or a single CMS demonstration. It will…

How Reimbursement Cuts Affect Margins in Post-Acute Care

Health Policy and Economics

How Reimbursement Cuts Affect Margins

Medicare post-acute care (PAC) reimbursement is increasingly driven by stricter federal spending controls, closer Medicare Advantage (MA) utilization oversight, and limited rate increases. Current policy priorities center on value-based accountability, shifts to lower-intensity care settings,…

Health Policy and Economics

Update: Medicare Advantage Prior Authorization

A review of Medicare Advantage prior authorization starts with an operational reality: a clinically appropriate service can be delayed, redirected, or denied before the provider ever has an opportunity to deliver it. For hospitals, skilled…

How Value Based Care Affects Healthcare Operators

Health Policy and Economics

The Impact of Value-Based Care

The practical question is not whether value-based care affects operators. It already does. The more consequential question is whether an organization recognizes the change early enough to redesign how it manages referrals, clinical performance, workforce…

CMS Withholds $1B in Medicaid Payments From CA, MN

Policy and Politics - Federal

CMS Defer $1B in Medicaid Payments to CA, MN

The report that CMS is withholding $1B in Medicaid payments from California and Minnesota is not merely another Washington-versus-state-capital political skirmish. It is a reminder that Medicaid is financed through a conditional partnership, and federal…

Fee for Service vs Value Based Care: What Changes

Health Policy and Economics

Fee for Service vs Value Based Care

A hospital can fill beds, a skilled nursing facility can maintain census, and a physician group can increase visits while the broader system still produces avoidable cost and uneven outcomes. That is the central tension…

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Reg

Healthcare executive, consultant, and author covering post-acute care, senior living, and the economics behind both - for 30+ years.

The Weekly Briffing

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