Reynold Bryan’s Post

If you thought healthcare providers and industry firms had overcome post-pandemic financial challenges, think again. Recent reports paint a bleak picture, with healthcare bankruptcies soaring by 71% between 2022 and 2023, reaching a five-year high, according to Revenue Intelligence. The study by Gibbins Advisers focused on Chapter 11 bankruptcy cases in the healthcare and medical sectors, revealing a significant increase in filings with liabilities exceeding $100 million. Hospital bankruptcies, in particular, reached their highest level since 2019. Another concerning report from Chartis indicates that half of the nation's rural hospitals are operating at a loss, the highest percentage in a decade. Public policy plays a role in these challenges. The implementation of the No Surprises Act has led to delays in reimbursements for hospitals and healthcare providers. Additionally, Medicare Advantage has been blamed for exacerbating financial strain, with a notable increase in enrollment among rural community residents. What, if anything, should Congress do to intervene? #HealthcareCrisis #FinancialStrain #BankruptcySurge #HealthcareIndustry #PublicPolicy #NoSurprisesAct #MedicareAdvantage #RuralHospitals #FinancialIntervention #CongressAction

This process is worthwhile to watch as it unfolds. Hospitals and healthcare systems haven’t necessarily done a great job integrating and managing physicians as experienced over time. The reality is independent physician practices and their cohort of outpatient services especially ASC’s are providing equal if not better outcomes at a fraction of the cost. You need to do the work and diligence to understand the reality today. Unfortunately the hospital lobby in Washington and elsewhere is large and dominates the political agenda. You can throw darts and other weapons at PE backed healthcare platforms but they overwhelmingly out perform hospital based care providers 24x7. Unfortunately PE doesn’t have the political support to do what it does best! Operative strategies back with deep capital and management talent to boot. We shall see soon enough who has the right stuff. My bet is on this independent physician practices backed by PE.

Destroying the independent physician: “Independent physicians have been receiving lower reimbursement rates than hospitals when delivering the same services to patients covered by government programs. The North Carolina Medicaid-expansion financing scheme further widened this payment gap, worsening the survival environment of independent physicians and pushing them to become employees of hospital systems.” …thus driving all clinicians into hospital employment, to be a cross between a tightly controlled Amazon factory worker or like a person on parole with an ankle tracker. Clinicians work in mammoth systems where the board is full of those from Wall St and banking, and not run by clinicians. I can see why so many doctors become anti-government …when government takes actions like these that are so anti-doctor and anti-patient. Destroying independent physicians (and, arguably, destroying the profession of medicine) to create impersonal systems of factory “care” is not pro-patient.

Such a great piece, Ge! There are not enough #EB #brokers and #consultants that understand the impacts of CMS policies on employers. The two are dangerously interconnected. There are many states that have similar #medicaid practices taking place, which creates another provider-led incentive for commercial rates to continue to increase. As a #payvider person, I also see the plight of the provider and the unique effects of sunk cost infrastructure that is virtually impossible to easily transition away from - especially when a provider’s high margin service lines subsidize community-based, high-value, low-reimbursement services. Not to mention that providers employ a large percentage of America’s working class - and growing! The web we weave as a sector seemingly becomes more delicate by the year.

Had some exposure in helping Medicaid Care Organization (MCO) in NC. During the rollout for Tailored/Standard Plan split - the state government requirements are so out-of-line (most MCOs couldn't keep up with implementation speed). I am generally open to Medicaid expansion (if done right), but NC didn't seem to know exactly what they were asking MCOs to do - basically re-do all provider contracting based on new Medicaid models, which has never been tried anywhere else. In what world is that possible in healthcare - implementation takes a whole year but the expectation was ever-changing requirements and deadlines on top of standard operations. Given that NC government had given lucrative Medicaid management to big commercial payers (one of its kind) few years prior, I can't help but question - "who's really directing this move?" Big payers saying "there's not enough $ in the reimbursement (thus revenue) to support this plan, because contracting is difficult with hospitals " The relationship between the NC hospital system monopoly, NC's special Medicaid plan/expansion contracts that went to Commercial insurers, Medicaid's 50 state/50 federal, NC government's tax revenue from these juggernaut systems - are prime target for all parties to involved to 📈 🆙 📈 prices across the board. I don't see a reason why healthcare costs would go down in any part of this picture - when everyone involved benefits, at the cost of NC's taxpayers (and some federal). Ge Bai thank you for covering this topic.

This is a fascinating article. There are many interesting dimensions to consider regarding the fact that "To win their support, the state and the Centers for Medicare and Medicaid Services (CMS) decided to reimburse hospitals for their Medicaid services at the commercial payment rates." (1) For employers in North Carolina in a market where a single carrier dominates and providers are looking to consolidate, where are the payers or companies focused on employers and employees as their true north star as customers? Where are the companies serving these needs across the country? (2) Does this show that government horse trades because they are optimizing their portfolio of programs? Is there a better need to coordinate between national & state policies and regulators? Does this make any one actor better than the other, or does it highlight a need for each actor to focus on creating value for the end consumer, and it's less complicated when you have a focus and business model that supports that focus? (3) It’s easy to criticize. But how do we make progress forward? I would personally love to hear more constructive dialogue across the board and see more bias towards action and sooner rather than later.

Our March blog post addresses the many financial struggles of rural healthcare providers, as well as methods to help alleviate them. https://lnkd.in/gTTEvMj9

Speaking of #MedicareOpenEnrollment (Oct. 15 - Dec. 7)... Beneficiaries should take this opportunity to re-evaluate how well their plan is working for their health needs and budget. Then, they can make changes if needed to optimize their coverage. These 3 steps will prepare them to make an informed decision. ✅👇 https://lnkd.in/ec-VS8VN

Are you ready for the Medicare Open Enrollment? Here tips on how to prepare.

Leavitt Partners' Sarah Hudson Scholle - MPH, DrPH, Kyle Levin, and Tanner Fliss have identified a set of eight policy options to reform the Medicare Advantage (MA) Quality Bonus Program (QBP) and the Star Ratings System in their newly release report, “Future Visions of Reform: Policy Options for The Medicare Advantage Quality Bonus Program and Star Ratings”. These policy options are intended to improve the MA program for its enrollees and meaningfully contribute to the fiscal sustainability of the Medicare program, as well as to preserve rewards and incentives for MA plans to provide high-quality care to their members. Read a summary and access the full report here: https://bityl.co/PIGs #Medicare #valuebasedhealthcare #MedicareSTARratings