National Daily Hospital Executive Briefing
(Wed, Dec 17, 2025)
(Wed, Dec 17, 2025)
Today
> CMS Pricing Talks to Base Reimbursement On ED Boarding Improvements / LOS
> Hospital At Home Extension Advances
> 12 Month Margin Forecasts, Quality Metrics and Strategic Recommendations
> Hospital At Home Extension Advances
> 12 Month Margin Forecasts, Quality Metrics and Strategic Recommendations
Global & Health Sector Headlines
News
- CMS pushes a major outpatient-payment and transparency package for CY 2026—framing the final OPPS/ASC changes as pro-patient transparency, program sustainability, and improved access. A noteworthy operational signal: CMS says it is adopting a measure to evaluate long waits in emergency departments, and is tightening how hospital “Safety of Care” influences Star Ratings (with future automatic downgrades for bottom-quartile safety performance).
https://www.cms.gov/newsroom/press-releases/cms-empowers-patients-boosts-transparency-modernizing-hospital-payments
Recommendations
- Treat CMS’ ED-wait and safety emphasis as a near-term reputational and referral risk, not just a compliance line item. Assign an executive owner now for: (1) ED waiting/boarding transparency readiness, (2) safety measure-group performance, and (3) external messaging.
More Details..
- Price transparency enforcement is moving from “posting files” to “actionable comparability.” CMS summarizes policy changes in the CY 2026 OPPS/ASC final rule package; use it as your checklist for what regulators and patients will actually look for next.
https://www.cms.gov/newsroom/fact-sheets/cy-2026-opps-ambulatory-surgical-center-final-rule-hospital-price-transparency-policy-changes
Health Policy & Industry Updates
News
- Hospital-at-Home extension advances: The House passed bipartisan legislation to extend the Acute Hospital Care at Home waiver through 2030, moving the issue to the Senate. This matters operationally because repeated expirations/short-term extensions destabilize staffing models, vendor contracts, and discharge alternatives during peak-capacity months.
https://www.aha.org/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program
Recommendations
- If you have (or want) a Hospital-at-Home capability, don’t wait for Senate timing: do a “readiness sprint” now.
- Confirm patient eligibility criteria, escalation protocols, and rapid-response coverage.
- Confirm payer mix exposure and which service lines most reliably shift to home.
- Pre-build a winter surge playbook that uses H@H to protect elective surgical throughput.
More Details...
- Congressional sponsors are positioning Hospital-at-Home explicitly as a capacity relief valve (and a cost/access strategy). This framing is useful internally when aligning medical staff, nursing, finance, and case management around a shared purpose: protect beds for the highest-acuity patients and preserve elective margin.
https://buchanan.house.gov/2025/12/buchanan-applauds-unanimous-house-passage-of-hospital-at-home
Emergency Department Boarding & Hospital Capacity
News
- AHRQ is signaling priority funding for interventions that reduce ED boarding and hospital crowding, explicitly tying boarding to patient-safety risk and care delays. This is a useful lever: when a federal research agency calls a phenomenon a safety issue, it strengthens the business case for cross-department throughput redesign.
https://www.ahrq.gov/news/noi-hsr-dept-boarding.html
Recommendations
- Use a “boarding-first” operating system for 60 days:
- Daily (weekday) executive throughput huddle with one goal: reduce time-to-inpatient-bed and time-to-discharge.
- Hard targets: discharge-by-noon reliability; % discharges before 1 PM; and a daily “avoidable delay” count.
- Escalation rules: if boarding exceeds a threshold (e.g., >10 admitted holds or >X minutes median boarding), activate a defined surge protocol.
More Details...
- Benchmarking data summarized by Becker’s (from EDBA reporting) suggests ED LOS improved in 2023 and boarding times fell versus 2022, but high-volume EDs still carried heavy boarding burdens. Use these reference points to set credible internal targets and to separate the “ED work” from the “hospital flow” work.
https://www.beckershospitalreview.com/care-coordination/ed-length-of-stay-falls-in-2023-3-takeaways/
(Optional additional operational lens: ACEP’s summary of AHRQ’s emphasis connects boarding to mortality, errors, LOS, costs, burnout, and ED violence—useful for aligning stakeholders.)
https://www.acep.org/news/acep-newsroom-articles/ahrq-announces-special-emphasis-on-research-to-reduce-boarding
Early Morning Briefing Highlights
- CMS is explicitly linking outpatient payment modernization with ED wait-time measurement and safety-weighted star ratings—expect public scrutiny of wait times and safety performance to intensify.
- Hospital-at-Home is trending toward longer-term authorization; if extended, it can be a meaningful capacity and LOS tool, especially when SNF/behavioral-health discharge constraints are the true choke point.
- National performance signals still show tight staffing, rising bad debt/charity, and uneven margins—a widening gap between strong and struggling performers.
Supporting source for national performance context:
https://www.kaufmanhall.com/insights-reports/national-hospital-flash-report
Forecasts for Tomorrow Today (“From your friendly Enhanced Intelligence, Chat!”)
- Large systems (multi-hospital, strong market share): Likelihood = Moderate. Over the next 12 months, expect operating margin dispersion to widen further: top performers may hold or improve by roughly +0.5 to +1.5 points, while weaker peers may drift -0.5 to -1.5 points if bad debt/charity and labor tightness persist. My best guess, after digesting the available news: the winners will be those who hardwire throughput discipline and protect elective access.
- Small/rural hospitals: Likelihood = High. Expect continued volatility driven by payer mix, workforce scarcity, and discharge constraints. My best guess: a meaningful subset will see flat to -1.0 points margin movement without aggressive access/throughput redesign, service-line focus, and external partnerships.
- Hospitals that operationalize capacity alternatives (Hospital-at-Home, rapid post-acute placement, home health expansion): Likelihood = Moderate. My best guess: these hospitals can claw back +0.5 to +1.0 points margin via lower LOS, fewer ED holds, and better surgical schedule protection—assuming clinical governance and escalation are robust.
Strategic Implications for Leadership (Top 5)
- CMS is elevating what patients feel (wait times) and what harms patients (safety) into higher-visibility scoring and policy—expect reputational/market consequences.
- ED boarding is not an ED problem; it is a discharge reliability + capacity management problem. The winning move is cross-department operating discipline.
- Hospital-at-Home is emerging as a practical “capacity instrument” for winter; readiness work now prevents late-season scrambling.
- Margin variation will continue; organizations that treat quality/flow as the most reliable margin levers will outperform.
- Transparency expectations are rising; treat public-facing metrics as strategic communications and operational truth.
Forecasting Today’s Weather (Seatbelts)
Scenario A (Moderate likelihood): ED waits become more publicly salient via new measures.
Metric forecast: higher scrutiny of ED time-to-provider and boarding thresholds; increased patient leakage risk for elective and ambulatory services.
Seatbelts now: (1) publish a clear internal ED access dashboard, (2) stand up daily discharge reliability, (3) tighten escalation/bed management.
Scenario B (Moderate likelihood): Hospital-at-Home extension moves forward; capability becomes a competitive differentiator.
Metric forecast: hospitals with stable H@H pathways reduce peak boarding and protect elective schedules.
Seatbelts now: (1) define patient cohorts, (2) vendor + staffing plan, (3) quality/safety monitoring (falls, escalation, readmits).
Quality Metrics to Share with Your Team (≤7)
- ED overall length of stay (LOS): Benchmark cited in EDBA summary suggests ~184 minutes (2023) (vs. ~205 minutes in 2022; ~182 in 2019). Target: sustain ≤180–190 minutes overall while tightening admitted-patient flow.
https://www.beckershospitalreview.com/care-coordination/ed-length-of-stay-falls-in-2023-3-takeaways/ - ED boarding time (admitted patients): EDBA summary notes national average boarding time declining in 2023; set a local target that steadily reduces boarded minutes and prevents multi-hour holds from becoming “normal operations.”
https://www.beckershospitalreview.com/care-coordination/ed-length-of-stay-falls-in-2023-3-takeaways/ - Discharge-by-noon reliability: Best-practice operational targets commonly aim for 30–40% of discharges by noon (or your local noon definition), with an improvement target of +10 points in 60–90 days when a daily operating system is installed. (Operational estimate; validate to local baseline.)
- Avoidable delay count (daily): Track number of patients medically ready but delayed >24 hours for non-clinical reasons. Target: reduce by 20–30% in 90 days through barrier removal and post-acute contracting.
- Safety of Care performance (Star Ratings sensitivity): CMS indicates future automatic downgrades for lowest-quartile safety performance; treat key safety measures as “tier-1 operational KPIs.”
https://www.cms.gov/newsroom/press-releases/cms-empowers-patients-boosts-transparency-modernizing-hospital-payments - Price transparency compliance readiness: % of required shoppable services and machine-readable file elements that match CMS expectations. Target: 100% completeness + “comparability” usability check.
https://www.cms.gov/newsroom/fact-sheets/cy-2026-opps-ambulatory-surgical-center-final-rule-hospital-price-transparency-policy-changes - National context metric (margin dispersion): Kaufman Hall publishes monthly national trend context; use it to communicate external pressure while staying focused on local controllables (flow, safety, access).
https://www.kaufmanhall.com/insights-reports/national-hospital-flash-report
Leadership Call to Action (≤5)
- Name an ED Boarding Owner (exec-level) and run a daily 20-minute throughput huddle for 60 days.
- Install discharge reliability: barrier list, unit targets, and escalation rules.
- Stand up H@H readiness: cohort definition + clinical governance + escalation and quality monitoring.
- Treat Safety of Care as strategic: prioritize the top safety measures that influence public ratings.
- Re-audit price transparency for “real-world usability,” not just file publication.
Permanent Footer
š Published at National Daily Hospital News
Published as part of the National Daily Hospital News series.
Visit the archive here: https://nationaldailyhospital.blogspot.com/
Connect with us:
LinkedIn: https://www.linkedin.com/in/spencetepper/
Facebook: https://www.facebook.com/Compirion
Number One Hospital Blog: https://bethenumber1hospital.blogspot.com/
© 2025 National Daily Hospital News
Principle Author: ChatGPT5
Editor: Spence Tepper
Permission to share freely given
#HospitalFinance
#HealthSystemFinance
#ClevelandClinic
#AdvocateHealth
#MassGeneralBrigham
#OhioStateWexnerMedicalCenter
#ClevelandClinicFlorida
#MayoClinic
##HospitalOps
#CMS
#HealthcareWorkforce
#PriceTransparency
#EDBoarding
#HospitalLeader
#NursingExecutive
#NursingLeader #EmergencyPhysician
#Nursing
#Hospitals
#CareManagement
#TransitionalCareManagement
#Telehealth
#HospitalAtHome
#Radiology
#SurgicalServices
#AmbulatorySurgicalCenter
#Medicare
#InfectionControl
#OperationsImprovement
#HospitalConsulting
#MRSA
No comments:
Post a Comment