January 26, 2024

Healthcare Authority Newsletter - January 2024 #3

W. Jerad Rissler

Arnall Golden Gregory LLP

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News Briefs

CMS Sets Prior Authorization Time Limits, Other Requirements

To combat growing criticism of prior authorization delays by payers, Centers for Medicare & Medicaid Services finalized a rule that requires health plans to send prior authorization decisions within three days for urgent requests and seven days for standard requests starting in 2026. The guidelines will affect Medicare Advantage, Medicaid, the Children's Health Insurance Program, Medicaid managed care, and qualified health plans.

(Source: FierceHealthcare, 2024-01-17)

Nearly 400 U.S. hospitals are owned by private equity investors, representing one out of every three for-profit hospitals, according to the Private Equity Stakeholder Project, a research and advocacy group. In the past couple of years, private equity's foray into hospital ownership has drawn public outrage and, increasingly, legislative scrutiny.

(Source: Medical Xpress, 2024-01-22)

Hospitals' immediate financial needs drove more than a quarter of the sector's merger and acquisition activity through 2023, which also brought a higher overall number of unveiled transactions than its predecessor, according to a new year-end dealmaking review from Kaufman Hall. Per the report, 65 hospital and health system deals were announced in 2023, which was up from 2022's 53, and total transacted revenue across 2023 was $38.4 billion.

(Source: FierceHealthcare, 2024-01-19)

Seventeen hospital associations and 30 providers filed amicus briefs in support of the American Hospital Association's suit against the HHS' restrictions on website tracking. In the briefs, the parties warn the restrictions would threaten their ability to provide needed health services.

(Source: Healthcare Dive, 2024-01-17)

Generic drugs are the singularity of American healthcare -- they are too cheap. And it's driving some manufacturers out of business altogether.

(Source: The Guardian, 2024-01-18)

Most physicians -- about 70 percent of them, in fact -- work on their days off and during vacations, while about 20 percent of physicians took less than one week of vacation during the previous year, research in JAMA Network Open has found. In uncovering the reasons behind this trend, researchers found concerns about finding cross-coverage for clinical responsibilities and concerns about the financial impact of taking vacation, such as not meeting productivity targets or continued overhead costs.

(Source: Healthcare Finance News, 2024-01-19)

As turnover rates, limited access, and job vacancies continue to plague the healthcare industry, many hospitals and health systems are turning to flexible work strategies to provide physicians with a proper work-life balance, manage costs, and improve operating margins. AMN Healthcare, the largest provider of healthcare interim leadership and executive search services in the U.S., recently put together a report highlighting how healthcare organizations can tackle the ongoing challenges being faced.

(Source: Becker's Hospital Review, 2024-01-17)

A new initiative and partnership between public schools and major health systems will create healthcare-centric high schools in various communities around the country that will graduate students directly into high-demand healthcare jobs with sustainable wages. The $250 million initiative will be spearheaded by Bloomberg Philanthropies, founded by Michael Bloomberg.

(Source: Healthcare Finance News, 2024-01-18)

The number of patient records exposed in data breaches doubled in 2023 compared to 2022, even as the count of breaches declined slightly, according to a report by cybersecurity firm Fortified Health Security. The report, which analyzed data from the HHS' Office for Civil Rights, found that more than 116 million records were compromised across 655 breaches. This shows a "significant peak in patient data exposure" that eclipsed an earlier high point in 2015, when three major breaches contributed to a spike in divulged health records.

(Source: Healthcare Dive, 2024-01-18)

The American Hospital Association warned hospitals of a validated IT help desk social engineering scheme and encouraged hospitals to remain vigilant and notify the Federal Bureau of Investigation if they fall victim to it. The scheme involves threat actors leveraging the stolen identities of revenue cycle employees or employees in other sensitive financial roles.

(Source: HealthIT Security, 2024-01-19)

In recent years, the skilled nursing sector has faced an escalating threat from cybercriminals, posing significant risks to the operations of nursing homes. Due to the rapid rise in use of technology since the COVID-19 pandemic, experts in the sector have noticed an uptick in cybercrime and insurance underwriters are demanding nursing homes protect themselves from these threats.

(Source: Skilled Nursing News, 2024-01-19)

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.