March 14, 2025

Article: CMS Pitches Shortening ACA Enrollment Period: 5 Things to Know

CMS is proposing a set of new regulations for ACA marketplaces, including shortening the annual enrollment window and rescinding eligibility for DACA recipients. In a March 10 news release, the agency said the changes are designed to address “the troubling amount of improper enrollments” in the marketplace. In the first quarter of 2024, CMS said it received 40,000 complaints of customers being enrolled in ACA plans, or switched into a new plan, without their knowledge.

Five things to know about the proposed rules:

• The agency pitched shortening the annual enrollment period by one month.
  • Under the proposed rule, open enrollment would run from Nov. 1 to Dec. 15.
  • Currently, the open enrollment period begins Nov. 1 and ends Jan. 15.
  • The change would align more closely with enrollment dates for employer-sponsored coverage, and
  • “reduce the risk of adverse selection from consumers who otherwise may wait to enroll until they need healthcare services,” according to the agency.
• The proposed rules would also eliminate a special enrollment period that allows individuals with incomes under 150% of the federal poverty limit to enroll in coverage in any month.
  • The policy “allows people to wait to enroll until they become sick,” the agency said.
• The regulation would reverse a proposal by the Biden administration that would have allowed Deferred Action for Childhood Arrival recipients to enroll in ACA plans.
  • The DACA program allows individuals brought to the U.S. as children without legal status to remain in the country.
  • In December 2024, a federal judge blocked DACA recipients from enrolling in ACA plans.
• Under the new regulations, consumers would be required to re-verify their eligibility for fully subsidized plans each year.
  • If enrollees do not verify their eligibility, they will pay a $5 monthly premium until they confirm or update their eligibility.
  • The change would cut back on fraud by ensuring individuals are aware of the coverage they are enrolled in, CMS said.
• The rule would bar insurers from covering “sex trait modification services,” or gender-affirming care, as essential health benefits.
  • The proposal would not prohibit health plans from voluntarily covering these services, the agency said.

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March 14, 2025

Whitepaper: Breaking Language Barriers: One Hospital’s Path to Patient Trust

Language barriers between patients and staff pose a significant threat to care quality and patient satisfaction, especially for hospitals serving diverse communities. These barriers can lead to care delays, miscommunication and frustration, affecting both patient trust and staff efficiency.

This case study explores how Onvida Health – formerly Yuma (Ariz.) Regional Medical Center – redesigned its language services program to refine daily operations, boost patient satisfaction and improve care outcomes. Learn how the system implemented practical solutions and operational changes to:

• Build patient trust
• Foster a culturally and linguistically inclusive environment
• Significantly improve language access and encounter times
• Achieve a 4.9/5 interpreter satisfaction rating

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March 14, 2025

Article: GLP-1s Reshape Key Service Lines: What to Know

Blockbuster GLP-1 medications like Ozempic and Wegovy are transforming patient care, altering surgery volumes and redefining the healthcare industry’s financial landscape.

The obesity drug market could reach $200 billion by 2031, according to industry projections. Perhaps unsurprisingly, some health systems and industry disruptors are expanding weight loss programs in response to the growing demand for GLP-1s.

Beyond weight loss programs, GLP-1 medications are influencing multiple hospital and ambulatory surgery center service lines. In healthcare C-suits, this trend in influencing long-term operational and financial decisions, especially as GLP-1 medicines affect elective surgery volumes.

Elective surgeries are a substantial revenue source for hospitals and ASCs, and several procedures could rapidly decline in volume over the next few years.

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March 11, 2025

AI in Healthcare 2025: Trends, Adoption, and the Evolving Regulatory Landscape

As artificial intelligence (AI) continues to evolve, healthcare organizations are increasingly exploring its potential to enhance both clinical and administrative workflows.

In an article published in January 2025 in HealthTech Magazine, the authors give an overview of 2025 AI trends they expect to see in healthcare over the coming year.  The article suggests AI adoption will grow, with a focus on tools that deliver tangible value, such as:

• Ambient listening technology for clinical documentation, and
• machine vision (adding cameras, sensors and microphones) for patient monitoring.

Generative AI solutions (AI that creates new content such as images and text), particularly those utilizing retrieval-augmented generation (RAG), are gaining traction as organizations seek to use chatbots that can access an organization’s information more accurately than in the past. Additionally, the article emphasizes the importance of data governance and IT infrastructure so that they can understand its own data and make it easier for IT teams to know how a solution will work in the organization’s environment. While AI presents transformative opportunities, its successful implementation depends on balancing innovation with regulatory compliance and strategic investment in technologies that address real-world challenges in patient care and operational efficiency.

With increased adoption comes greater scrutiny, prompting a rise in AI-related regulations. The healthcare sector is already seeing regulatory developments such as the Office of the National Coordinator for Health Information Technology’s HTI-1 Final Rule, which governs health data and interoperability.

Additionally, organizations are seeking guidance on AI governance to mitigate risks and ensure responsible use. These concerns have driven recent legislative efforts at both the federal and state levels to regulate AI in healthcare. Legislation we have already seen on the federal level include S. 501, which would require the Department of Health and Human Services to develop strategies to address AI-related public health threats, while H.R. 193 directs guidance on Medicare payments for AI-powered devices like continuous glucose monitors.

State legislatures are also taking action.  Examples include Connecticut’s SB 10 and Montana’s HB 556 ensuring AI cannot replace clinical judgment in insurance determinations, and Maryland’s HB 1240 prohibiting AI tools that prioritize cost savings over patient care quality. These measures reflect a growing push to balance AI’s potential benefits with safeguards that maintain ethical and patient-centered healthcare.

For more information, read the full HealthTech Magazine article.

March 11, 2025

Upcoming Medicare Telehealth Changes: What You Need to Know

Recent confusion has spread on social media about Medicare’s telehealth coverage, with some falsely claiming that all coverage will end on April 1, 2025. While it is true that Medicare’s expanded telehealth waivers are set to expire on March 31, 2025, telehealth coverage will not disappear entirely.

Additionally, there is a chance that Congress passes a bill to further extend the telehealth waivers before the March 31, 2025, deadline. In fact, the draft Continuing Resolution released on March 8 includes an extension of the telehealth flexibilities through September 30, 2025. However, passage of the continuing resolution is not guaranteed so it is important for providers to be aware of the policy landscape they may face should the telehealth waivers not be extended.

Without Congressional action to extend these waivers, stricter geographic and site restrictions will return, meaning only patients in rural areas and certain medical facilities will qualify for Medicare-covered telehealth.

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March 4, 2025

Article: The Million-Dollar Question on CFO’s Minds in 2025

As hospital and health systems continue to face challenges like rising costs, reimbursement, emerging from COVID-19 margins and potential policy changes, many CFOs are working to find strategies to ensure financial sustainability while maintaining patient care.

While no one has a crystal ball for answers, Becker’s connected with health system CFOs to discuss how solutions like leveraging automation and alternative payment models can help address certain pressures to ensure long-term industry success.

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