National Daily Hospital Executive Briefing Wednesday December 3rd, 2025

 NATIONAL DAILY HOSPITAL NEWS — EXECUTIVE BRIEFING

Wednesday, December 2, 2025

Today:

>Medicare Spending Outpaces Revenue

>Hospital Bad Debt Expected to Rise

>Surgery Migration Accelerates

>Emergency Services Workforce Challenges Persist

This Executive Briefing summarizes key developments impacting hospital leaders today, with links, takeaways, and action steps.

---

1. Hospital Finance / Margin / Revenue & Reimbursement

1. Medicare Spending Growth Outpaces Revenue for Hospitals in 2024
   CMS National Health Expenditure (NHE) data show hospital spending and input costs continuing to rise faster than many payment streams, sustaining negative Medicare margins for rural and urban hospitals.
   https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet
   
   

2. 2025 Commercial Contracting Pressures: Employers Accelerate Site-Neutral Policies
   Policymakers and purchasers are pushing to align payments for outpatient services across sites of care, with Medicare site-neutral reforms likely to spill over into commercial contracting and employer benefit strategies in 2025.
   https://www.kff.org/medicare/five-things-to-know-about-medicare-site-neutral-payment-reforms/
   
   

3. Hospital Bad Debt Expected to Rise in 2025
   Analyses of uncompensated care trends indicate hospital bad debt levels are climbing again as inflation, higher premiums, and cost-sharing burdens strain patients’ ability to pay.
   https://www.beckershospitalreview.com/finance/hospital-bad-debt-is-getting-worse/
   
   

4. Medicaid Redeterminations Continue to Drive Volume Instability
   KFF’s Medicaid Enrollment and Unwinding Tracker shows millions losing coverage during redeterminations—many for procedural reasons—fueling ED volumes and uncompensated care, especially at safety-net hospitals.
   https://www.kff.org/medicaid/medicaid-enrollment-and-unwinding-tracker/
   
   

5. Outpatient Surgery Migration Accelerates
   New reporting on ambulatory surgery centers (ASCs) highlights rapid growth in ASC volumes and investments, reflecting continued migration of profitable procedures away from hospital outpatient departments.
   https://www.healthcarefinancenews.com/news/ambulatory-surgery-centers-expand-revenues-investments-surge
   
   

---

2. ED Throughput / Boarding / Patient Flow

1. CMS Tightens Focus on ED Flow Metrics in OPPS/OQR Programs
   CMS’s proposed ECAT (Emergency Care Access & Timeliness) measure emphasizes ED boarding time ≤4 hours and ED LOS ≤8 hours, signaling how future quality programs may benchmark admitted patient flow.
   https://blog.medisolv.com/articles/2026-opps-proposed-rule-the-major-changes-to-outpatient-quality-reporting
   
   

2. Boarding Times Rising for High-Acuity Patients
   Recent research links high hospital occupancy to prolonged ED boarding, with national guidance increasingly citing four hours as a maximum acceptable boarding time and highlighting safety risks when exceeded.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC9526134/
   
   

3. Emergency Physician Workforce Pressures Persist
   ACEP workforce and compensation reports show persistent staffing challenges, regional disparities, and ongoing pressure to fill rural and community ED positions despite an evolving national labor market.
   https://www.acep.org/life-as-a-physician/careers/salary-surveys---emergency-medicine
   
   

4. Case Study — ICU “Bed-Ahead” Policy Cuts ED LOS and Complications
   A trauma center that pre-assigned one SICU bed for the next critical patient reduced ED length of stay, complications, and in-hospital mortality—illustrating how “bed-ahead” flow protocols can relieve ED boarding.
   https://cdn.ymaws.com/www.traumacenters.org/resource/collection/7CBDB021-6A53-4F5F-A1A2-DD8B2EADA780/PI-2%20The%20Impact%20of%20a%20%E2%80%9CBed%20Ahead%E2%80%9D%20Policy%20on%20ED%20.pdf
   
   

5. Ambulance Diversion Increasing in High-Volume Markets
   California’s 2025 Emergency Departments Almanac documents that ambulance diversion hours nearly tripled statewide between 2013 and 2023, underscoring the downstream impact of ED boarding and access block.
   https://www.chcf.org/wp-content/uploads/2025/02/CaliforniaEmergencyDepartmentsAlmanac2025.pdf
   
   

---

3. Early Morning Briefing Highlights

1. Hospitals Expected to Face Elevated Workforce Vacancy Risk into 2025
   The AHA’s 2025 Health Care Workforce Scan highlights ongoing challenges in recruiting and retaining clinical staff, with persistent vacancy and burnout risk even as some turnover indicators improve.
   https://www.aonl.org/news/AHA-Releases-2025-Workforce-Scan
   
   

2. Joint Commission Emphasizes High-Risk Transitions of Care in 2025 Updates
   Updated Joint Commission guidance reinforces expectations around timely, complete transition records and medication reconciliation during handoffs from hospital to the next level of care.
   https://manual.jointcommission.org/releases/TJC2025A/DataElem0415.html
   
   

---

4. Strategic Implications for Leadership

• Prepare for persistent negative Medicare margins by updating payer-mix models, stress-testing financial projections under site-neutral payment scenarios, and accelerating service-line cost transparency.
  
  

• Reassess ED throughput strategies with a focus on decision-to-admit times, behavioral health flow, standardized escalation rules, and proactive capacity planning on inpatient units.
  
  

• Stabilize workforce plans by anticipating 2025 vacancy trends, strengthening internal float pools, and expanding hybrid staffing models that improve retention while controlling premium labor.
  
  

• Increase operational resilience as site-neutral momentum and outpatient migration shift volume and revenue away from hospital campuses toward ASCs and freestanding sites.
  
  

• Tighten transition-of-care pathways to align with Joint Commission and CMS expectations for timely, complete transitions and reduced post-discharge risk.
  
  

---

Quality Metrics to Share With Your Team (≤7)

1. Hospital Medicare Margin (National Trend)
   CMS NHE and related analyses continue to show hospital expenses rising faster than many payment streams, contributing to persistent negative Medicare margins.
   https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet
   
   

2. ED Boarding & Occupancy Risk
   Research links ED boarding beyond four hours to worse outcomes and ties prolonged boarding to high hospital occupancy and access block.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC9526134/
   
   

3. ED Flow Targets — Boarding and LOS
   CMS’s proposed ECAT measure specifies ED boarding time ≤4 hours and ED length of stay ≤8 hours as key thresholds for admitted patients.
   https://blog.medisolv.com/articles/2026-opps-proposed-rule-the-major-changes-to-outpatient-quality-reporting
   
   

4. Ambulance Diversion Growth
   In California, ambulance diversion hours increased 172% between 2013 and 2023, reflecting rising ED crowding and inpatient capacity constraints.
   https://www.chcf.org/wp-content/uploads/2025/02/CaliforniaEmergencyDepartmentsAlmanac2025.pdf
   
   

5. Bad Debt & Uncompensated Care Pressure
   Analyses point to worsening hospital bad debt as patients face higher deductibles and cost-sharing obligations.
   https://www.beckershospitalreview.com/finance/hospital-bad-debt-is-getting-worse/
   
   

6. Outpatient Procedure Migration to ASCs
   Growth in ASC volumes and investments signals continued migration of profitable procedures away from hospital outpatient departments.
   https://www.healthcarefinancenews.com/news/ambulatory-surgery-centers-expand-revenues-investments-surge
   
   

7. Workforce Vacancy and Burnout Risk
   The 2025 AHA Workforce Scan documents ongoing shortages and emphasizes retention, well-being, and flexible staffing models as key levers.
   https://www.aonl.org/news/AHA-Releases-2025-Workforce-Scan
   
   

---

Leadership Call to Action (≤5)

1. Run a 2025–2027 Medicare Margin & Payer-Mix Simulation
   Incorporate revised Medicare and commercial payment assumptions, site-neutral scenarios, and ASC migration into multi-year financial projections.
   
   

2. Implement or Tighten a “Bed-Ahead” Protocol
   Work with ICU and inpatient units to pre-assign capacity for ED admissions, with clear triage rules and escalation triggers to reduce decision-to-admit delays.
   
   

3. Revise Behavioral Health Throughput Plan
   Create or update a behavioral health flow playbook with defined boarding thresholds, telepsychiatry options, rapid placement pathways, and on-call escalation.
   
   

4. Rebuild Workforce Pipelines and Internal Flex Capacity
   Use the AHA Workforce Scan findings to prioritize residency affiliations, local training partnerships, and cross-training strategies that reduce reliance on premium labor.
   
   

5. Standardize Transition-of-Care Checklists and Metrics
   Align discharge and handoff workflows with 2025 Joint Commission expectations, including a measurable transition-record and medication-reconciliation process.
   
   

---

📍 Published at National Daily Hospital News
#HospitalOps #CMS #HealthcareWorkforce #HospitalFinance #EmergencyServices #HospitalLeader #NursingExecutive #NursingLeader #EmergencyPhysician #Nursing #Hospitals #CaseManagement #EmergencyNurse

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
Principal Author: ChatGPT5
Editor: Spence Tepper
Permission to share freely given