National Daily Hospital Executive Briefing Thursday November 6th, 2025

 

National Daily Hospital News — Executive Briefing Thursday November 6th, 2025

The Government Shutdown Issue and Playbook

Date: November 6, 2025

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Hospital Reimbursement & Margins — News, Recommendations, Case Studies

1. NEWS: Kaufman Hall’s National Hospital Flash Report (July 2025) shows performance softening, with expense growth outpacing revenue growth and pressuring margins.
   https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-july-2025-data
   
   

2. NEWS: CMS finalized the CY 2026 Physician Fee Schedule (Oct 31, 2025), with policy changes and adjustments affecting Part B payments starting Jan 1, 2026.
   https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f
   
   

3. RECOMMENDATION: Kaufman Hall advises close management of non-labor expense growth and service-line profitability as margins soften mid-2025.
   https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-july-2025-data
   
   

4. CASE STUDY: Kaufman Hall monthly flash reports aggregate > 1,300 hospitals — use their benchmarks to compare CYTD Operating Margin Index versus peers (New Case Study).
   https://www.kaufmanhall.com/insights-reports/national-hospital-flash-report
   
   

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Impact of the Federal Government Shutdown & Medicare Changes — News, Recommendations, Case Studies

1. NEWS: HHS contingency plan states Medicare program operations continue during a lapse in appropriations, with non-discretionary activities prioritized.
   https://www.hhs.gov/about/budget/fy-2026-cms-contingency-staffing-plan/index.html
   
   

2. NEWS: Reuters: CMS recalled furloughed staff (announced Oct 23, 2025) to support Medicare and ACA open enrollment amid the shutdown.
   https://www.reuters.com/business/healthcare-pharmaceuticals/us-medicare-agency-recalls-furloughed-staff-support-open-enrollment-despite-2025-10-23/
   
   

3. NEWS: AMA: During the shutdown, CMS retains ~53 percent of staff for essential operations; survey/certification and some rulemaking slow or pause.
   https://www.ama-assn.org/health-care-advocacy/advocacy-update/oct-3-2025-advocacy-update-spotlight-government-shutdown
   
   

4. RECOMMENDATION: MGMA: Expect MACs to hold and then process certain claims affected by expired legislative provisions; monitor payment-timing changes.
   https://www.mgma.com/federal-policy-resources/cms-shutdown-update
   
   

5. CASE STUDY: Investopedia outlines which Medicare functions continue (enrollment, care), helping patient-facing teams set expectations (Case Study as Shared Previously if used).
   https://www.investopedia.com/how-a-government-shutdown-could-affect-your-social-security-and-medicare-benefits-11821644
   
   

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Emergency Department Throughput — News, Recommendations, Case Studies

1. NEWS: Health Affairs Scholar (2025) — Boarding drives lower patient satisfaction and worse outcomes; calls for whole-system solutions.
   https://academic.oup.com/healthaffairsscholar/article/3/9/qxaf168/8241101
   
   

2. RECOMMENDATION: 2025 open-access study reports reducing ED length of stay by implementing fast-track and process redesign; focus on door-to-treatment intervals.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC12268096/
   
   

3. CASE STUDY: 2025 quality-improvement report — Multidisciplinary discharge-before-noon focus improved hospital throughput and reduced avoidable delays (New Case Study).
   https://pmc.ncbi.nlm.nih.gov/articles/PMC11838157/
   
   

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Quality Metrics to Share with Your Team (from sources above)

1. Kaufman Hall (July 2025): Hospitals reported expense growth outpacing revenue growth, contributing to margin softening (Operating Margin Index trend).
   https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-july-2025-data
   
   

2. CMS PFS Final Rule (CY 2026): Effective Jan 1, 2026; includes policy updates affecting Part B payments.
   https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f
   
   

3. HHS/CMS Shutdown Plan (Oct 2025): CMS to continue Medicare operations; Medicaid Q1 FY 2026 funded via advance appropriation.
   https://www.hhs.gov/about/budget/fy-2026-cms-contingency-staffing-plan/index.html
   
   

4. AMA (Oct 3, 2025): CMS retains ~53% of staff for essential operations during shutdown.
   https://www.ama-assn.org/health-care-advocacy/advocacy-update/oct-3-2025-advocacy-update-spotlight-government-shutdown
   
   

5. Reuters (Oct 23, 2025): CMS recalled staff to support open enrollment during shutdown.
   https://www.reuters.com/business/healthcare-pharmaceuticals/us-medicare-agency-recalls-furloughed-staff-support-open-enrollment-despite-2025-10-23/
   
   

6. Health Affairs Scholar (2025): Prolonged ED boarding correlates with lower patient satisfaction and higher morbidity/mortality in older adults.
   https://academic.oup.com/healthaffairsscholar/article/3/9/qxaf168/8241101
   
   

7. QI Study (2025): Multidisciplinary discharge-timing initiative improved throughput; consider “discharge before noon” targets.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC11838157/
   
   

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Leadership Call to Action

1. Stand up a 60-day non-labor cost review with weekly service-line P&L huddles to counter margin softening noted in mid-2025 benchmarks.
   https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-july-2025-data
   
   

2. Model CY-2026 Medicare Part B revenue under the new PFS and update your payer-mix and pro-formas by specialty.
   https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f
   
   

3. Activate a shutdown playbook: verify MAC processing status, escalation paths, and patient-communication scripts.
   https://www.mgma.com/federal-policy-resources/cms-shutdown-update
   
   

4. Adopt an ED boarding reduction bundle: hospital-wide bed meetings q4h, discharge-by-noon targets, and fast-track flow for low-acuity cohorts.
   https://academic.oup.com/healthaffairsscholar/article/3/9/qxaf168/8241101
   
   

5. Publish a one-pager for patients and staff clarifying what Medicare services continue during a shutdown.
   https://www.hhs.gov/about/budget/fy-2026-cms-contingency-staffing-plan/index.html
   
   

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