Most Hospital Revenue Is Not From Patient Care
A new Trilliant Health analysis shows that hospitals generate only about one‑third of their gross revenue from patient care, with a median of 29.9% in 2024. The share varies widely, from 8.3% to 86.6%, and is lower for for‑profit facilities (28.8%) than for faith‑based nonprofits (49.3%). Nonpatient‑related revenue and expenses now play a substantial role, accounting for roughly 16% of operating costs and supporting many hospitals that posted negative operating margins in 2023. The findings highlight growing financial reliance on investments, grants and ancillary services such as device sales and pharmacy operations.
Jill Geisler: What’s a Leader to Do when Good Employees Leave?
Employee turnover is inevitable, but how leaders respond shapes culture and future talent. Jill Geisler outlines five truths: resignations aren’t disloyalty, managers’ reactions are observed, stories matter, pipelines reduce disruption, and boomerang hiring is rising. Respectful exits preserve morale, generate...
HFMA Annual Conference 2026 Reimagines the On-Site Experience
The Healthcare Financial Management Association (HFMA) will host its 2026 Annual Conference June 7‑10 at the Gaylord Resort & Conference Center in National Harbor, Maryland, drawing more than 4,000 finance leaders and solution partners. The event introduces a reimagined on‑site...
Why Hospitals Should Develop a Billable Supply Policy
Hospitals face billing ambiguity for medical supplies under IPPS and OPPS, where many items are bundled into procedure payments. A clear billable supply policy distinguishes routine from non‑routine items, preventing inconsistent patient charges and aiding charge capture. The article outlines...
Health System PBM Ownership Model Shows Benefits Amid Reform Pressure
St. Louis‑based SSM Health co‑owns Navitus Health Solutions, a pharmacy‑benefit manager serving 18 million members across 800 clients nationwide. Navitus differentiates itself with a fully transparent, pass‑through pricing model that avoids hidden mark‑ups and spread pricing. The approach comes as Congress...
Why Revenue Cycle Teams Must Prepare for Extended Downtime in the Age of Cyber Threats
Healthcare providers face escalating ransomware and cloud‑outage threats that can instantly cripple revenue cycle operations, halting claim submissions and cash flow. Recent incidents, such as the Change Healthcare clearinghouse outage and a regional system’s backup encryption, exposed critical blind spots...
Kiran Batheja: Collaboration Yields Results
HFMA’s "Lead Now" initiative capitalized on the One Big Beautiful Bill Act of 2025, driving unprecedented growth and engagement across the healthcare finance sector. Membership surged to over 145,000—the highest in its 80‑year history—while more than 1,080 volunteers delivered 197,000...
States Weigh Hospital Price Caps
Several states are weighing legislation to cap hospital charges relative to Medicare rates. Maine’s original 200% Medicare cap was softened to limit price hikes for specific insurance plans, while Delaware proposes a 250% cap that could trim $413 million from hospital...
Revenue Cycle as Enterprise Infrastructure: Building Financial Resilience in 2026
Healthcare finance leaders are redefining the revenue cycle as a core enterprise capability rather than a back‑office function. In 2026, organizations must align revenue cycle strategy with overall financial goals, adopt AI and predictive analytics under strong governance, and redesign...
MedPAC Says Hospital Payments Are Sufficient, Urges Better Safety-Net Targeting
MedPAC’s 2026 annual report to Congress concludes that Medicare’s statutory payment update of roughly 2.3% for FY 27 is sufficient and does not merit an extra boost. Hospital financial health is improving, with all‑payer operating margins rising from 5.2% in 2023...
Getting Bang for the Buck From AI: Insight From Privia Health
Privia Health, a publicly traded physician‑management firm, has embarked on a systematic AI rollout across its revenue cycle after interviewing roughly 30 vendors. The company piloted tools for denials management, accounts‑receivable follow‑up, prior authorizations, coding and patient demographics, then began...
2026 MAP Awards Presented to 20 Organizations for Revenue Cycle Performance
The Healthcare Financial Management Association (HFMA) announced the 2026 MAP Award winners, recognizing 20 organizations for high‑performance revenue cycle management. Recipients include three integrated delivery systems, eight hospital systems, four individual hospitals, two critical‑access hospitals, and three physician practices. Winners...
FastFinance: Hospital Building Surge; AI-Coding Study Pushback
Health systems are set to spend a record amount this year on new hospital construction, outpacing budgets for outpatient clinics and ambulatory surgery centers. The Health Resources and Services Administration projects a 39% increase in demand for long‑term care workers...
Despite Pressures, Healthcare Construction Spending to Increase
Construction spending for hospitals and clinics is set to hit $30.7 billion in 2026, an 11.6% jump from 2025 and the highest level since the 2024 record. ConstructConnect projects a 7% compounded annual growth rate, reaching $38.8 billion by 2030, driven by...
Finances Drive REH Conversion
Mercy Hospital in Moundridge, Kansas, converted to a Rural Emergency Hospital (REH) on Jan. 1, 2024, swapping inpatient services for 24‑hour emergency care and outpatient offerings. The REH model provides a $3.4 million annual facility payment and 105% of the OPPS rate,...
The Future of Accountable Care
Nick Hut and Katie Gilfillan outline a forthcoming accountable care organization (ACO) model slated for 2027. The proposal calls for deeper financial risk sharing, real‑time analytics, and a stronger focus on patient‑centered outcomes. It builds on recent CMS payment reforms...
Hospitals Can Use 2026 to Prepare for CMS TEAM Bundled Payment Risk
The CMS Transforming Episode Accountability Model (TEAM) is a mandatory five‑year bundled‑payment program affecting roughly 750 hospitals in 188 markets. 2026 serves as an upside‑only rehearsal year, but starting in 2027 up to 20 % of a hospital’s target reimbursement for...
From Billing to Strategy: Elevating the Patient Financial Experience
Patient financial experience has shifted from a back‑office billing function to a strategic, end‑to‑end service that directly impacts revenue integrity and brand trust. Research shows that transparent cost estimates and digital, omni‑channel payment options improve patient engagement, reduce disputes, and...
Medicare Claims Processing Modernization Gains Urgency at CMS
The U.S. Department of Government Efficiency is pushing CMS to replace the decades‑old COBOL‑based Medicare claims system with a real‑time, cloud‑native platform. CMS issued an RFI in January seeking vendors capable of supporting at least two million members and processing...
FastFinance: Physician Unionizing Push; Trans Services Rules
Health systems are confronting an accelerating physician unionization movement, adding pressure to labor negotiations amid a broader wave of strikes. A new “Weird Number” reveals that 20 states now require minimum income thresholds for patients receiving free or discounted services,...
Physicians Increasingly Targeted for Unionization
Physician unionization is accelerating as healthcare unions expand beyond nurses to target doctors. Membership of the intern‑resident‑fellow union more than doubled, reaching over 40,000 by 2025, and the new SEIU Doctors United group is launching a national campaign to organize...
Costs Loom Amid Evolving Trans Care Policies
Hospital groups and state attorneys general are urging the Centers for Medicare & Medicaid Services to withdraw two proposed rules that would ban gender‑affirming, or “sex‑rejecting,” procedures for minors and prohibit Medicaid and CHIP payments for such care. CMS estimates...
Medicare GME Funding Reform Debate Focuses on Rural Hospitals
A congressional hearing highlighted that current Medicare GME funding formulas leave rural hospitals like Phelps Health struggling to bridge the $5‑$7 million gap between planning grants and accreditation costs. Hospital leaders argue that outdated per‑resident caps and rigid grant structures create...
Drive Strategic Growth with Smarter Workforce Planning
U.S. hospitals are pairing enterprise resource planning (ERP) systems with AI‑powered human capital management (HCM) platforms to tighten workforce planning as clinical services expand. Leaders at Johns Hopkins, Henry Ford and Rush describe multi‑year integrations that promise real‑time staffing visibility,...
HFMA CEO Jordan, Healthcare Leaders Point to Urgency of Affordability Challenges During ViVE Conference
At the ViVE health‑tech conference, HFMA CEO Ann Jordan led a panel that warned the industry that healthcare affordability is an urgent, systemic problem. The discussion highlighted the Vitalic Health initiative, which seeks to marry financial sustainability with better outcomes,...
Q&A: Financial Lessons From Northwell’s ACO
Northwell Health, a long‑time participant in the Medicare Shared Savings Program, has generated shared savings while treating about 90,000 attributed beneficiaries and is gearing up for downside risk in 2027. The system focused on care coordination, especially mental‑health screening and...
Why Rural Hospital Finances Improved in 2025
Rural hospitals in the United States posted a notable financial turnaround in 2025, with the median operating margin climbing to 2.0% from a negative 0.1% in 2023. The proportion of facilities operating in the red fell from 50% to 41.2%,...
Gen AI Is Coming for Medical Bills; 3 Ways to Prepare
Patients are turning to generative AI tools like ChatGPT to question and dramatically reduce their medical bills, with high‑profile cases showing savings of over $150,000. OpenAI reports nearly 2 million weekly messages about health insurance, indicating a surge in consumer‑driven AI...
Consequences of New MA and ACA Marketplace Regulations
CMS has released draft regulations that will reshape Medicare Advantage (MA) and Affordable Care Act (ACA) Marketplace operations beginning in the 2027 compliance year. The proposals tighten enrollment verification, mandate greater cost and benefit transparency, and introduce stricter documentation standards...
How to Optimize the Revenue Cycle Workforce in 2026
Health systems face margin pressure, rising patient cost responsibility, and payer complexity, prompting a shift in revenue cycle workforce design for 2026. Integrating AI-driven automation with a strategically aligned global workforce and robust governance can improve denial management, clean claim...
Relief Might Be Fleeting for the Healthcare Industry After Supreme Court Strikes Down Most Tariffs
The Supreme Court ruled 6‑3 that most Trump‑era tariffs imposed under the International Emergency Economic Powers Act are invalid, wiping out 25% duties on Canadian and Mexican imports and a 20% hike on China. Sector‑specific duties on steel, aluminum and...
Rising Healthcare Costs Strain Health System Margins
Healthcare spending surged as higher service volume boosted hospital revenues but also drove operating costs higher, pushing the median health‑system margin down to 1.3% in December from 1.5% in November. Labor expenses rose 4.2% year‑over‑year while supply costs jumped 12.3%,...
Hospitals Mount Response as Site-Neutral Payment Policy Progresses
Hospital groups warn that expanding site‑neutral Medicare payment could slash revenues by $182 billion over the next decade, with rural facilities facing a $26.3 billion hit. The FTI Consulting report, commissioned by the Coalition to Strengthen America’s Healthcare, projects an 8% cut...
FastFinance: Cost Implications of New HOPD Reporting Rules; Election Year Opportunity on Affordability
HFMA’s FastFinance podcast highlights new off‑campus HOPD reporting requirements that could impose significant cost burdens on health systems. The episode also cites a "Weird Number"—a 3‑5% annual net revenue loss attributed to inefficient electronic health records and billing platforms. Additionally,...
Big Financial Impacts From Off-Campus HOPD Rule Change
Effective Jan. 1 2028, the Consolidated Appropriations Act of 2026 requires hospitals to assign separate NPIs and submit two provider‑based attestations for each off‑campus hospital outpatient department (HOPD) or lose Medicare OPPS reimbursement. Compliance documentation can be extensive—up to 200 pages per...
CMS Provides More Leeway to Medicaid State-Directed Payments Before New Limits Kick In
CMS issued new guidance that widens the grandfathering window for Medicaid state‑directed payments (SDPs), allowing states to lock in higher rates through business‑day calculations. The expanded windows—Oct 11 2024 to July 3 2025 and July 7 2025 to March 27 2026—let providers preserve rates above the caps that...
Transparency in Coverage Proposed Rule Aims to Make Price Files More Usable
The U.S. Department of Health and Human Services has issued a December proposed rule to overhaul the Transparency in Coverage (TiC) machine‑readable files, with implementation slated for 2027. The rule would filter out payment rates that never apply to a...
CMS Proposes 2027 ACA Marketplace Changes to Address Rising Premiums
CMS released a proposed rule for the 2027 ACA marketplaces aimed at curbing rising premiums and stabilizing enrollment after enhanced subsidies expired in 2026. The rule would allow non‑network plans to sell on the exchanges, extend catastrophic coverage terms up...
Updated Documentation Requirements in Medicare Could Add Burden on Healthcare Providers
The Centers for Medicare & Medicaid Services (CMS) issued a regulatory update effective April 13 that expands documentation, face‑to‑face (F2F) and prior‑authorization requirements for Medicare‑covered DMEPOS items. Eight new oxygen‑related codes join the F2F/WOPD list, while seven additional items—five orthoses and...
