National Daily Hospital Executive Briefing Wednesday November 12th, 2025

National Daily Hospital Executive Briefing

Wednesday, November 12, 2025

Global & Health Sector Headlines — News, Recommendations, and Case Studies

1) News — CMS finalized the CY 2026 Medicare Physician Fee Schedule on Oct. 31, 2025; policy changes begin Jan 1, 2026, with separate conversion factors for QPs and non‑QPs. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f

2) Recommendation — Prepare side‑by‑side PFS impact modeling by service line and clinician type given the dual conversion factors; check telehealth and supervision updates. https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other

3) News — Medicare telehealth and Acute Hospital Care at Home faced uncertainty during the October funding lapse; plan contingencies for coverage gaps. https://bipartisanpolicy.org/article/medicares-acute-hospital-care-at-home-initiative-lapses-amid-shutdown/

4) Case Study as Shared Previously — As of July 2025, ~400 hospitals across 142 systems in 39 states were approved for Hospital‑at‑Home; programs remain sensitive to federal renewals. https://www.aha.org/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program

5) News — CMS continues to post hospital price‑transparency enforcement actions and CMP notices; verify your machine‑readable and shoppable files. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions

Hospital Finance (Margins/Revenue/Reimbursement) — News, Recommendations, and Case Studies

1) News — Kaufman Hall’s latest Flash Report (Nov. 12, 2025) shows September operating margins steady around low‑single digits amid expense pressure and drug‑cost growth. https://www.beckershospitalreview.com/finance/hospital-margins-steady-amid-disruption-5-notes/

2) Recommendation — Stand up a weekly margin huddle to compare run‑rate vs. PFS/OPPS 2026 changes and re‑base labor and purchased services when margins fall below 2%. https://www.cms.gov/newsroom/press-releases/cms-proposes-bold-reforms-modernize-hospital-payments-strengthen-transparency-and-put-patients-back

3) New Case Study — Systems report using rolling 13‑week cash forecasting linked to price‑transparency remediation to reduce denials and bad‑debt exposure; align revenue cycle work with transparency audits. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency

Emergency Department Triage & Throughput — News, Recommendations, and Case Studies

1) News — AHRQ’s national summit report concludes ED boarding is a hospital‑level flow problem requiring inpatient capacity and discharge solutions. https://www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdf

2) Recommendation — Implement a hospital‑wide Expected Date of Discharge (EDD) within 24 hours of admission and reinforce via daily bed huddles to cut non‑medical delays. https://www.ahrq.gov/news/newsletters/e-newsletter/951.html

3) Case Study as Shared Previously — National analyses show rising percentages of patients waiting >4 hours for a bed; treat hallway care and surge protocols as temporary, safety‑gated levers. https://respiratory-therapy.com/disorders-diseases/critical-care/emergency-room/emergency-department-wait-times-are-rising/

Early Morning Briefing Highlights

• CY 2026 PFS is final; model by service line and APM status before January 1. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f

• Margins steady but fragile; expense growth outpaces revenue in several categories (notably drugs). https://www.beckershospitalreview.com/finance/hospital-margins-steady-amid-disruption-5-notes/

• Hospital‑at‑Home reauthorization uncertainty persists; plan contingencies. https://bipartisanpolicy.org/article/medicares-acute-hospital-care-at-home-initiative-lapses-amid-shutdown/

• Boarding is a whole‑hospital flow issue; expand discharge and inpatient capacity tools. https://www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdf

Strategic Implications for Leadership

1) Translate the PFS final rule into department‑level RVU and revenue targets; adjust scheduling templates and supervision policies ahead of Jan 1. https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other

2) Use rolling 13‑week cash forecasts and denials analytics to prioritize revenue cycle fixes with high EBITDA impact; include price‑transparency remediation. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions

3) Institutionalize EDD in the first 24 hours and daily bed huddles; pair with noon‑discharge standard work. https://www.ahrq.gov/news/newsletters/e-newsletter/951.html

4) Prepare a Hospital‑at‑Home fallback plan (swing capacity + home‑based care partners) in case of federal program lapses or delays. https://bipartisanpolicy.org/article/medicares-acute-hospital-care-at-home-initiative-lapses-amid-shutdown/

5) Refresh OPPS/ASC and IPPS 2026 education for service line leaders as final rules publish and payer contracts roll over. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient

Quality Metrics to Share with Your Team (≤7)

1) Finance — Sept 2025 operating margins around low‑single digits; Kaufman Hall cites expense pressure and drug costs as headwinds. https://www.beckershospitalreview.com/finance/hospital-margins-steady-amid-disruption-5-notes/

2) Policy — CY 2026 PFS effective Jan 1, 2026; distinct conversion factors for QPs vs. non‑QPs. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f

3) Flow — ED boarding designated a public health crisis; solutions must extend beyond ED to inpatient flow and discharge. https://www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdf

4) Access — Hospital‑at‑Home authority lapsed Sept 30, 2025 absent Congressional renewal; plan for coverage uncertainty. https://bipartisanpolicy.org/article/medicares-acute-hospital-care-at-home-initiative-lapses-amid-shutdown/

5) Compliance — CMS maintains a live list of price‑transparency enforcement actions; audit machine‑readable and shoppable files monthly. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions

6) Operations — Noon‑discharge and daily EDD review associated with fewer non‑medical delays and improved throughput. https://www.ahrq.gov/news/newsletters/e-newsletter/951.html

7) Outlook — OPPS/ASC CY 2026 updates will continue to shape site‑of‑care and ASC strategy. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient

Leadership Call to Action (≤5)

1) Stand up a PFS 2026 readiness sprint: model revenue impact by CPT/HCPCS, validate supervision/telehealth rules, and brief medical staff. https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other

2) Launch a 60‑day price‑transparency remediation and monthly audit cycle to minimize penalties and denials. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions

3) Implement EDD‑within‑24‑hours and noon‑discharge standard work across units to reduce boarding and LOS. https://www.ahrq.gov/news/newsletters/e-newsletter/951.html

4) Build a Hospital‑at‑Home contingency plan with partner agencies and remote monitoring vendors in case of reimbursement gaps. https://bipartisanpolicy.org/article/medicares-acute-hospital-care-at-home-initiative-lapses-amid-shutdown/

5) Refresh OPPS/ASC 2026 education for perioperative and ambulatory leaders; align block time and ASC strategy with expected rate changes. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient

National Daily Hospital News

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