Trump's new CMS chief vows to crush fraud, waste and abuse

By Allison Bell - Dr. Mehmet Oz — now the administrator of the Centers for Medicare and Medicaid Services — is starting off by talking about improving health care system integrity. "One of my first priorities is going to be to crush fraud, waste, and abuse," Oz said in a video posted Thursday on the CMS YouTube channel. "I'm going to have more news on that coming soon." Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. CMS Administrator Oz Prioritizes Price Transparency and Reducing Paperwork: Newly confirmed CMS administrator Dr. Oz outlined three key health policy priorities: helping patients better understand what their care will cost, reducing the administrative burden on healthcare providers by minimizing unnecessary paperwork, and updating the ACA public exchange system to better meet modern needs and improve consumer access.

2. Employee Health Benefits Not Yet Addressed: Oz has not yet commented on group health coverage or employee health benefits, which may be due to the delayed confirmation of Daniel Aronowitz, President Trump’s nominee to lead the Employee Benefits Security Administration (EBSA). EBSA is a key agency in implementing ACA rules that affect employer-sponsored health plans and commercial insurance markets.

3. Plans to Streamline Prior Authorization Processes: Reflecting concerns raised during his Senate confirmation hearing, Oz appears poised to tackle provider challenges with health plan authorization procedures. He has suggested creating a concise, standardized list of procedures that could be subject to prior authorization, aiming to simplify the process and reduce delays in patient care.

Some Tax-Exempt Hospitals Are Building Genuine Estate Empires

By Wendell Potter - A new investigation by The Lever has exposed how some of America’s most powerful hospital systems — those enjoying the protections and privileges of nonprofit status — are quietly amassing vast real estate empires, tax-free. The report zeroes in on the University of Pittsburgh Medical Center (UPMC), a health care behemoth that now owns more than $2 billion in tax-exempt property in Allegheny County alone, raising serious questions about whether these institutions are fulfilling their public mission — or simply getting rich. Read Full Article… 

HVBA Article Summary

1. Nonprofit hospitals prioritize profit over care: The article reveals how nonprofit health systems like UPMC are increasingly operating like corporations—channeling funds meant for community benefit into executive compensation, international ventures, and even luxury expenses like a $50 million corporate jet. This occurs despite serious local needs, such as the fact that one in five Pittsburgh residents lives below the poverty line.

2. Hospital monopolies distort local economies and politics: UPMC’s growing dominance in Pennsylvania is not only driving up healthcare costs but also reshaping city landscapes and power structures. A federal labor lawsuit and reporting from The Lever suggest that UPMC is leveraging its wealth to influence local elections, contributing heavily to political candidates who shift their stances after receiving donations.

3. Calls for accountability in exchange for tax breaks: With 80% of nonprofit hospitals failing to provide community benefits equal to their tax exemptions, the article urges a reevaluation of whether these institutions are fulfilling their public mission. It argues that tax subsidies were intended to support care for the underserved—not to fuel real estate empires or political influence—making a strong case for greater transparency and oversight.

1 big thing: New push to halt assaults of health workers

By Tina Reed - A new round of workplace violence in hospitals and clinics is lending urgency to efforts to create a first-ever federal standard for protecting nurses, social workers and others in the medical system. Why it matters: Health care workers routinely rank in government statistics as among the likeliest to experience threats or assault on the job. But there's no nationwide requirement for health systems to perform hazard assessments, train employees about dangers or inform them of their rights. Read Full Article…

HVBA Article Summary

1. New Legislation on Violence Prevention: Senator Tammy Baldwin and Representative Joe Courtney have introduced a bill that would mandate all health care employers to develop and implement comprehensive workplace violence prevention plans. This legislative push, backed by National Nurses United, comes after previous attempts to criminalize assaults on hospital staff failed due to concerns about penalizing patients.

2. Rising Threats to Health Workers: The proposed legislation is driven by a surge in violent incidents within hospital settings, including hostage situations and shootings. A 2024 survey by the nurses’ union revealed that 8 in 10 nurses reported experiencing violence on the job in the past year, highlighting a widespread and persistent safety crisis.

3. Current Measures and Gaps: Despite over 60% of hospitals already having violence prevention plans, experts say more robust and standardized protections are needed. The American Hospital Association is working with the FBI to analyze trends and improve safety infrastructure, while hospitals are increasingly turning to facility design enhancements to help deter violent behavior.

How cutting Medicaid would affect long-term care and family caregivers

By Kat McGowan - As Congress looks for ways to reduce the federal deficit, Medicaid is in the spotlight. Last week, the GOP-led House passed a budget framework that allows both chambers of Congress to work on a major budget plan they expect to pass without any Democratic votes. Some House Republicans have called for it to include reductions in Medicaid spending. Read Full Article…

HVBA Article Summary

1. Cuts to Medicaid threaten long-term care access and stability: Medicaid is the largest funder of long-term care, covering over half of the $415 billion spent annually and 60% of extended nursing-home stays. Proposed budget changes could reduce Medicaid’s growth, putting at risk essential in-home and community-based services that help 4.5 million elderly and disabled individuals remain at home.

2. Family caregivers face rising financial and emotional strain: Cuts would likely reduce services or tighten eligibility, forcing more responsibility onto unpaid caregivers. Already stretched, many spend over $7,000 out of pocket annually. Reduced support could lead to increased hospitalizations, institutionalization, and financial hardship for families providing daily care.

3. Budget strategy may overlook real-world consequences: While some policymakers argue slower Medicaid growth could curb costs or encourage long-term care insurance uptake, most families lack alternatives. With assisted living averaging $70,800 and private nursing rooms exceeding $127,000 annually, middle-class families risk being priced out of care, especially if home-based services are deprioritized.

Providers, payers struggle with CMS interoperability rule

By Hannah Nelson - Healthcare stakeholders are facing significant challenges in meeting the requirements of the CMS Advancing Interoperability and Improving Prior Authorization Final Rule, also known as CMS-0057-F, according to new survey results from the Workgroup for Electronic Data Interchange (WEDI). Read Full Article…

HVBA Article Summary

1. Final Rule and Compliance Timeline: The CMS final rule mandates that impacted healthcare entities implement APIs for patient access, provider access, payer-to-payer exchange, and prior authorization by January 1, 2027. Covered payers must also begin publicly reporting designated prior authorization metrics by January 1, 2026, aiming to reduce administrative burdens and streamline data sharing.

2. Readiness and Challenges: A large portion of providers (52%) and payers (43%) have not yet begun API implementation, citing key challenges such as insufficient funding, lack of interoperability strategy, and complexity of health information exchange networks. Cost uncertainty remains high, especially among providers, while payers anticipate $1–$5 million in implementation costs.

3. Stakeholder Support and Education Needs: The majority of clearinghouses (84%) and vendors (81%) plan to support compliance efforts, though fewer vendors are focused on consumer-facing APIs. Top educational needs across stakeholders include guidance on industry best practices, workflow adaptation, and technical training for API implementation, reflecting the complexity and scale of the transition.

Home-Delivered Medical Meals Could Prevent Millions Of Hospitalizations A Year

By HealthDay - Home-delivered meals tailored to people’s chronic illnesses can prevent hospitalizations, help folks remain healthy and save billions of dollars each year, a new study says. In “Food Is Medicine” programs, people with conditions like diabetes, heart disease or cancer receive prepared meals that are crafted to help protect their health. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Widespread eligibility and major cost savings: Over 14 million Americans qualify for medically tailored meals, with a nationwide rollout projected to save $32 billion in healthcare costs in the first year alone. The program would prevent more than 3.5 million hospitalizations annually, particularly for diabetes, heart disease, and cancer-related complications.

2. State-level financial impact: Medically tailored meals were cost-saving in 49 out of 50 states, with per-patient savings reaching up to $6,299 in Connecticut. Even in Alabama—the only state where cost savings weren’t achieved—the program still offered significant health benefits.

3. High efficiency for preventing hospitalizations: The simulation found that in states like Maryland, providing medically tailored meals to just 2.3 patients could prevent one hospitalization. Nearly 90% of eligible individuals are on Medicare or Medicaid, and 16 states have already approved or proposed Medicaid waivers to support this initiative.

46% of organisations are prioritising technology to support benefits management

By Zoe Wickens - Almost half (46%) of multinational organisations said they are prioritising the use of employee-facing technology to support benefits management, according to new research by Towers Watson. For its latest Global priorities for employee benefits survey, the Willis Towers Watson business surveyed 264 global organisations. It found that many are looking to expand their use of AI and other advanced technologies to improve benefits navigation and decision-making. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Data, cost, and engagement drive benefit strategies: A majority of employers prioritize data-driven insights (52%) and cost management (75%) to enhance employee benefits. Most (79%) also focus on promoting benefits to boost awareness and engagement, recognizing benefits as key to attracting and retaining talent (65%).

2. Global standards and cross-country strategies gain traction: Employers are increasingly aligning benefits with DEI and ESG priorities (52%), setting global minimum standards (70%), and planning to adopt cross-country approaches for life, health, retirement, and savings benefits (50%).

3. Benefits reflect employer values and employee expectations: Leaders emphasize that benefits now serve as a signal of organizational values. Advanced technologies and employee listening programs are seen as essential tools to tailor benefits, close the gap between employer offerings and employee needs, and deliver a consumer-grade experience.