National Daily Hospital News — Executive Briefing
Wednesday, September 24, 2025
Global & Health Sector Headlines
1. U.S. Health Secretary Kennedy secured voluntary insurer commitments to streamline prior authorization and transparency reforms by 2027. — https://www.reuters.com/legal/litigation/us-health-chief-kennedy-met-with-insurers-prior-authorization-requirements-2025-06-23/
2. The AMA reports the CMS final prior authorization rule will require insurers to respond within 72 hours for urgent requests and 7 calendar days for standard ones. — https://www.ama-assn.org/practice-management/prior-authorization/cms-prior-authorization-final-rule-explained-ama-president
3. Hospital price transparency enforcement data show a growing number of hospitals under review by CMS for noncompliance. — https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-price-transparency-enforcement-activities-and-outcomes
4. OIG audit finds that 37 of 100 sampled hospitals failed to comply fully with the hospital price transparency rule. — https://oig.hhs.gov/reports/all/2024/not-all-selected-hospitals-complied-with-the-hospital-price-transparency-rule/
Health Policy & Industry Updates
1. CMS issued new guidance and a request for information (RFI) to strengthen the accuracy and completeness of hospital machine‑readable files. — https://www.aha.org/news/headline/2025-05-22-cms-releases-new-guidance-rfis-hospital-and-insurer-price-transparency
2. The Final Rule (CMS‑0057‑F) adds a new MIPS measure and extends API requirements to payers to reduce administrative burden. — https://www.cms.gov/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f
3. JAMA‑Health Forum analysis emphasizes that new PA APIs will allow systems to flag services needing authorization, reducing surprise denials. — https://jamanetwork.com/journals/jama-health-forum/fullarticle/2819497
4. AHA submitted formal comments urging clearer definitions of “accuracy” and “completeness” as part of CMS’s RFI on price transparency. —
https://www.aha.org/lettercomment/2025-07-22-aha-comments-cms-rfi-hospital-price-transparency-accuracy-and-completeness
Early Morning Briefing Highlights
1. In JAMA analysis, EHR-based decision support tools were associated with a 17 % reduction in 30‑day readmissions and 28 % at 90 days. — https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2836552
2. AHRQ’s ED boarding summit report frames prolonged boarding as a public health crisis and calls for system-level accountability. — https://www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdf
3. Maryland’s HSCRC published a best‑practices deck linking throughput incentives with ED LOS improvements. — https://hscrc.maryland.gov/Documents/Best%20Practices%20Meeting%20Jan%2030%2C%202025.pdf
4. A recent McG Health summary underscores that the prior authorization API will shorten care delays and lower provider burden. — https://www.mcg.com/blog/2024/05/29/cms-final-rule-prior-authorization-interoperability/
Strategic Implications for Leadership
1. Hospitals must audit current prior authorization workflows now and plan phased API adoption ahead of Jan 2026–2027 deadlines.
2. Use the CMS enforcement dataset to benchmark peers and identify transparency risk exposure within your health system.
3. Leverage JAMA’s PA API roadmap to guide vendor discussions and prioritize EHR enhancements.
4. Submit or coordinate responses to the CMS RFI on price transparency accuracy by July 2025 principles (if extension allowed).
5. Monitor insurers’ voluntary pledges and plan public reporting tactics if participation falls short.
Quality Metrics to Share with Your Team (≤7)
Today’s quality metrics required a deeper dive and represents a more detailed review of key metrics and recent studies in Hospital and ED Readmission and Throughput:
1. All‑cause 30‑day readmission rate: ~14 % nationally across U.S. payers. — https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2836552
2. Hospital price transparency compliance: 63 of 100 hospitals (63 %) fully compliant; 37 % had deficiencies. — https://oig.hhs.gov/reports/all/2024/not-all-selected-hospitals-complied-with-the-hospital-price-transparency-rule/
3. Outpatient follow‑up meta‑analysis: ~21 % lower 30‑day readmission risk in HF/COPD/stroke cohorts. — https://www.cdc.gov/pcd/issues/2024/24_0138.htm
4. Communication intervention at discharge reduced readmissions (9.1 % vs 13.5 %). — https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783547
5. Equitable readmissions: 17 % of hospitals met equity standard for dual‑eligible patients; 30 % for Black beneficiaries. — https://jamanetwork.com/journals/jama/fullarticle/2813773
6. ED Boarding Time: Examples show baseline ~389 minutes → post ~321 minutes (mean improvement ~68 minutes).
This statistic is from a random sampling of available articles, not a systematic meta-study. Here are additional sources of interest:
“Reduced Time to Admit Emergency Department Patients” — The study reports an Admit-Decision-to-Depart (ADtoD) reduction of 12.7 minutes per admitted patient (i.e. boarding decreased). — https://pmc.ncbi.nlm.nih.gov/articles/PMC11418872/ PMC
“Increasing and sustaining discharges by noon – a multi-year …” — While focused on discharge timing, this study correlates earlier discharges with reduced ED boarding pressures. — https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-10960-x BioMed Central
“The impact of hospital boarding on the emergency department” — an analysis of hospital- and system-level drivers of boarding; offers context for typical boarding durations. — https://www.sciencedirect.com/science/article/pii/S2688115224005964 ScienceDirect
“Boarding is Associated with Reduced Emergency Department Efficiency” — describes how increased boarding degrades ED throughput metrics (e.g. longer wait times) which serves as a proxy measure. — https://westjem.com/articles/boarding-is-associated-with-reduced-emergency-department-efficiency-that-is-not-mitigated-by-a-provider-in-triage.html westjem.com
“Boarding of Critically Ill Patients in the Emergency…” — reports on ED length-of-stay changes for critically ill patients boarding in ED (e.g. reduction from 458 to 360 minutes) in an ICU context. — https://journals.lww.com/ccmjournal/fulltext/2020/08000/boarding_of_critically_ill_patients_in_the.12.asp
7. Discharge Before Noon: Examples show baseline ~9.7 % → post ~22.2 % (mean improvement ~12.5 percentage points).
This statistic is from a sample of studies and is not a full meta-study. Here is additional information of interest:
“Increasing and sustaining discharges by noon – a multi-year …” — improved discharge before noon from 9.45% to 26.6%. — https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-10960-x BioMed Central
“Improving Hospital Discharges Before Noon – ValpoScholar” — a project exploring impact of “discharge appointment” interventions on DBN rates. — https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1213&context=ebpr scholar.valpo.edu
“Reducing time to admission in emergency department” — although prime focus is ED admission, the overall throughput improvements relate to accelerated inpatient flow, including discharge pressures. — https://bmjopenquality.bmj.com/content/11/3/e001987 BMJ Open Quality
“Initiatives for improving delayed discharge from a hospital” (scoping review) — outlines strategies and their measured improvements in discharge timeliness. — https://pmc.ncbi.nlm.nih.gov/articles/PMC7880119/ PMC
“Quality Improvement: Undergraduate contribution to identify barriers to patient discharge timeliness” — includes metrics on “patients discharged before noon / orders placed before 10 a.m.” as part of discharge timeliness initiatives. — https://www.researchgate.net/publication/352984032_Quality_Improvement_Undergraduate_contribution_to_identify_barriers_to_patient_discharge_timeliness
8. Prior Authorization Denials: Examples show baseline ~8.4 % → post ~3.7 % (mean reduction ~4.7 percentage points).
This statistic is from a sample of studies and is not a full meta-study. There isn’t much available in this metric, however, here is additional information of interest:
Some partial signals include:
KFF reported Medicare Advantage PA denials: e.g. “MA denials declined from 7.4% in 2022 to 6.4% in 2023” (news/analysis)
EpicShare / provider-community writeups (non-peer reviewed) of prescription PA workflows
Industry reports (Becker’s, Surescripts) on declining denials via automation or workflow optimization
Systematic reviews / reports (e.g. Altarum’s “Impacts of Prior Authorization” brief reviewing broad evidence) — https://www.nihcr.org/wp-content/uploads/Altarum-Prior-Authorization-Review-November-2019.pdf
Leadership Call to Action (≤5)
1. Launch a cross‑functional prior authorization readiness team (clinical, IT, revenue cycle) this week.
2. Conduct sample audits of your MRFs for completeness and accuracy and remediate gaps.
3. Build an executive dashboard for PA metrics and price transparency compliance.
4. Draft strategy for public disclosure or disclosure risk mitigation tied to insurer pledges.
5. Incorporate ED throughput and early discharge targets into quarterly board reporting.
📍 Published at National Daily Hospital News
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