Executive Briefing Saturday, September 13th, 2025

 

Hospital Margin / Revenue / Reimbursement

News: U.S. hospitals and health systems in 2023 absorbed $130 billion in underpayments from Medicare and Medicaid, with reimbursement growing much slower than inflation, according to the AHA’s “Costs of Caring” report. — https://www.aha.org/costsofcaring
Recommendation: Hospitals should enhance revenue integrity programs, especially via charge capture optimization, to recoup lost funds from undercoding, overlooked outpatient services, and payer-denial gaps. (Rural hospitals particularly stand to benefit.) — https://www.ruralhealth.us/blogs/2025/06/rural-hospitals-unlock-hidden-revenue-with-charge-capture
Case Study: A multi-site rural hospital network implemented enhanced charge capture tools, scanning for missed outpatient codes and boosting net patient revenue by 8-12% without adding major staff. — https://www.ruralhealth.us/blogs/2025/06/rural-hospitals-unlock-hidden-revenue-with-charge-capture

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Hospital Inpatient Throughput

News: A multiyear study showed discharges before noon increased from 9.45% to 26.6% over 41 months with no adverse impact on readmissions or mortality, driven by earlier discharge orders. — https://pmc.ncbi.nlm.nih.gov/articles/PMC11025149/
Recommendation: Standardize early order entry (by 10 a.m.), daily multidisciplinary discharge rounds, and visible expected discharge dates to pull work earlier and sustain DBN gains. — https://pmc.ncbi.nlm.nih.gov/articles/PMC11025149/
Case Study: A multidisciplinary throughput program increased discharge orders before 9 a.m. from 4% to 16% and discharges before 11 a.m. from 7% to 19%, without harming patient experience. — https://journals.lww.com/pqs/fulltext/2025/03000/enhancing_hospital_throughput__a_multidisciplinary.1.aspx

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Hospital Emergency Department Throughput

News: A study from 2025 shows operational strategies like point-of-care testing and introducing liaison physicians in triage reduced ED crowding and length of stay significantly. — https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14946
Recommendation: Deploy triage liaison staffing and expand point-of-care diagnostics capacity to decrease door-to-treatment time and prevent LWBS (Left Without Being Seen). — https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14946
Case Study: In the cited hospital, after implementation, LWBS declined by ~28% and total ED length of stay in the targeted population dropped by ~25%. — https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14946

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Hospital Bed Placement Throughput

News: U.S. hospitals and health systems closed Q2 2025 with stable operating margins around 1%, even as drug and non-labor costs surged; outpatient revenue rose 12.3% year-over-year, inpatient revenue climbed 7.0%, and overall gross operating revenue rose 10.3%. — https://www.stratadecision.com/press-release/hospital-and-health-system-operating-margins-stabilized-throughout-q2-despite-rising
Recommendation: Use early discharge-order targets and coordinated rounds to smooth same-day bed placement; DBN improvements correlate with fewer non-medical delays and faster bed turns. — https://pmc.ncbi.nlm.nih.gov/articles/PMC11025149/
Case Study: One hospital system saw a drop in bed assignment delay times by nearly 20% after implementing cross-unit coordination and daily capacity huddles. — https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14946

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Hospital Patient Satisfaction / Engagement

News: Implementing bedside interprofessional rounds improved communication and increased patient satisfaction while supporting timely discharges. — https://pmc.ncbi.nlm.nih.gov/articles/PMC12015713/
Recommendation: Pair IDRs + proactive discharge communication (expected time, transport, meds) to keep satisfaction stable even as throughput accelerates. — https://pmc.ncbi.nlm.nih.gov/articles/PMC12015713/
Case Study: Post-implementation, staff reported better team-to-patient communication and more comprehensive care plans; patient experience scores improved during the 7-month evaluation period. — https://pmc.ncbi.nlm.nih.gov/articles/PMC12015713/

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Patient Safety / Culture of Safety

News: AHA reports Medicare reimburses only 83 cents for each dollar hospitals spend caring for patients in 2023, showing growing financial risk that correlates with challenges to sustaining safety protocols. — https://www.aha.org/costsofcaring
Recommendation: Invest in cross-training staff and maintain critical safety staffing levels even under financial strain to preserve culture of safety and avoid lapses. — https://www.aha.org/costsofcaring
Case Study: Hospitals with robust safety programs report fewer sentinel events and better employee retention even in years when underpayments and expense growth are high. — https://www.aha.org/costsofcaring

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Quality Metrics to Share with Your Team

1. Hospitals absorbed $130 billion in underpayments from Medicare & Medicaid in 2023. — https://www.aha.org/costsofcaring

2. Average net patient revenue per U.S. hospital (2023): $242.5 million; operating expenses: $251.5 million. — https://www.stratadecision.com/press-release/hospital-and-health-system-operating-margins-stabilized-throughout-q2-despite-rising

3. LWBS (Left Without Being Seen) drop: about 28% decrease in LWBS among rapid-assessment ESI 3-5 patients in an ED with vertical flow model. — https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14946

4. ED length of stay reductions: ~25% in focused flow pathways (vertical flow / rapid assessment) after operational redesign. — https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14946

5. LOS reduction: 0.6 days shorter average stay in an inpatient discharge redesign case. — https://journals.lww.com/pqs/fulltext/2025/03000/enhancing_hospital_throughput__a_multidisciplinary.1.aspx

6. Between 2019-2023, average net patient revenue rose from ~$192.5M to ~$242.5M—a ~$50M increase. — https://www.stratadecision.com/press-release/hospital-and-health-system-operating-margins-stabilized-throughout-q2-despite-rising

7. Inflation vs. payment growth gap: general inflation rose ~14.1% (2022-24) vs Medicare inpatient payment increases ~5.1%. — https://www.aha.org/costsofcaring

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Leadership Call to Action

1. Prioritize establishing or strengthening revenue integrity and charge capture teams, especially in rural and under-resourced hospitals.

2. Stand up multidisciplinary discharge rounds and checklists to reduce LOS and increase early discharges.

3. Reduce ED delays and LWBS by deploying liaison physicians, expanding diagnostics in triage, and designing vertical flow or rapid assessment pathways.

4. Safeguard safety and staffing protocols even under financial pressure — avoid cutting critical safety roles that can lead to worse outcomes and higher costs later.

5. Advocate for policy action to narrow the reimbursement-inflation gap—through CMS, state Medicaid, and payer negotiations.

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📍 Published at National Daily Hospital News
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