Latest news with #KaufmanHall
Yahoo
5 days ago
- Health
- Yahoo
Physicians are working more but reimbursement isn't keeping pace, report finds
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. Dive Brief: Physicians are working more than ever, but reimbursement isn't rising in tandem. It's a worrying mismatch that could translate into access problems for patients down the line, according to a new report. Physician productivity, as measured by a metric of how much work goes into providing a specific service, has grown 11% over the last two years, according to the report from consultancy Kaufman Hall. However, patient revenue per each work relative value unit dropped 7% over that time — and provider compensation per work relative value unit dipped 2%, Kaufman Hall found. Dive Insight: Physicians have been sounding warning bells for years about unsustainable reimbursement. Medicare reimbursement for physician services fell 29% from 2001 to 2024 when adjusted for inflation, according to the American Medical Association. The reimbursement shortfall stems from the fact that Medicare's payment to doctors isn't adjusted for inflation, and year-to-year adjustments are required to be budget neutral. Regulators say this makes it impossible for them to bump reimbursement to the level doctors say they need. Meanwhile, Medicaid rates for physician services are even lower than in Medicare — and higher reimbursement from commercially insured patients often fails to make up the difference, according to doctors. Reimbursement pressures have recently coincided with sharp inflation and rising labor expenses, resulting in winnowing margins for physician practices. That's led many to sell, often to large corporate buyers like hospitals or insurance companies, or close altogether. Other physicians are leaning more into expensive elective care or switching to concierge medicine to entice wealthier patients into their practices. But either way, access to physicians is shrinking for many Americans, experts say. 'Revenue has increased because physicians and providers are working more, but the data also show that reimbursement is not keeping pace. In the coming months if more patients lose insurance coverage, this trend will likely get worse,' Matthew Bates, the managing director and physician enterprise service line leader at Kaufman Hall, said in a statement alongside the release of the report Monday. Roughly 10 million Americans are expected to lose health insurance coverage as a result of the GOP's mammoth tax and policy law passed last month. Another 4 million should lose coverage if more generous subsidies for Affordable Care Act plans expire at the end of this year, according to estimates from nonpartisan scorekeeper the Congressional Budget Office. Some lawmakers in Congress have expressed support for reforming doctor reimbursement in hearings and in public letters. One policy, to link annual Medicare reimbursement updates to a measure of cost inflation, is backed by physician associations, an influential congressional advisory group and legislators on both sides of the aisle. (A bipartisan group of representatives introduced a bill in the House two years ago making the change, but it's seen little movement.) A recent CMS rule overhauling the physician payment system includes a Medicare base rate hike of 2.5% for doctors next year. But other policies in the rule means its impact on reimbursement will vary wildly based on a physician's specialty and site of practice. As such, it was met with mixed reactions from doctors. Recommended Reading CMS proposes rule aligning Medicare physician payment with 'Big Beautiful Bill,' MACRA Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Forbes
6 days ago
- Health
- Forbes
More Evidence Your Doctor's Working Harder Than Ever
Physician productivity continues to rise as doctors see heavier workloads in part due to a shortage of medical care providers and an influx of patients following the end of the Covid-19 pandemic. The latest evidence of this trend is a report from Vizient's KaufmanHall consulting firm that shows net patient revenue per provider rose 4% to $404,116 in the second quarter of this year compared to $389,040 in the same period a year ago. Meanwhile, per-physician work relative value units (wRVUs), a key measure of physician productivity, rose 6% in the second quarter compared to the year-ago period. 'Physician productivity rose,' the KaufmannHall report shows. 'Corresponding increases in revenue and expenses indicate that physicians are working more.' The report comes amid an intensifying shortage of physicians seeing more and more patients whose healthcare needs are greater. Part of this is related to demographics as baby boomers age but the main driver of compensation and related productivity is physicians are simply busier and there aren't enough of them. The Association of American Medical Colleges says the United States will face a physician shortage of up to 86,000 physicians by 2036, according to a report the group released last year though a bipartisan group of U.S. Senators is pushing legislation to lift a cap on Medicare funding for residencies. Similar legislation has been proposed in the U.S. House of Representatives. The KaufmanHall report, which is based on data from more than 200,000 employed physicians and advanced practice providers in more than 100 specialties, follows similar reports earlier this year on physician compensation and productivity. The American Medical Group Association (AMGA) 2025 Medical Group Compensation and Productivity Survey, which showed a 4.9% compensation increase across its entire dataset, said work relative value units (wRVUs) increased 1.5% overall and that often correlates to increase in patient visits, which grew by 2.3%. 'We are at this tipping point,' AMGA Consulting's chief operating officer Mike Coppola said in an interview earlier this year. 'You cannot keep driving compensation increases through productivity. Volume is being driven on the backs of physicians and that is hard to sustain.'
Axios
7 days ago
- Health
- Axios
Why more doctors can't make ends meet
America's doctors are working harder and getting paid less. And that could soon translate into less access for some patients. The big picture: A new report from consultancy Kaufman Hall shows primary care physicians and specialists are delivering more services since the pandemic. But they're not making more money because of stagnant reimbursements from public and private insurers and inflation. The data helps explain why medical practice bankruptcies hit a six-year high last year — and why some providers are shifting to pricey procedures for cash-paying customers to boost their bottom lines. By the numbers: There was a roughly 5% increase in net revenue per full-time provider between the second quarters of 2023 and 2025, Kaufman Hall said, based on data from more than 200,000 clinicians across the country. But over the same period, the amount of net revenue per unit of work — generally understood to mean how much a physician generates for the volume of work they put in — fell 7%, the report found. Between the lines: A reckoning may not be far off, with millions of Americans projected to lose coverage due to changes in Republicans' tax-and-spending bill. "In the coming months if more patients lose insurance coverage, this trend will likely get worse," said Kaufman Hall managing director Matthew Bates. The anticipated drop-off in income is compounded by rising labor costs, which already make up 84% of total expenses for medical groups. And some physicians struggle to find and hold on to good help. "At some point this growth in productivity starts to be impeded if the doctor has to go out and check in their own patients and take their vitals, they're not gonna be able to see as many patients," Bates said. The end of the COVID-19 crisis didn't improve business for many practitioners, as troubling trends that surfaced during COVID-19 have persisted. The consultancy Gibbins Advisors found there were 57 medical practice bankruptcies with more than $10 million in liabilities last year. While the bankruptcy filings have slowed this year, Clare Moylan, a principal at Gibbins, said it doesn't necessarily signal a turnaround. "The health care sector has a lot of macro shifts causing distress for providers," she said, pointing to persistent workforce shortages, elevated supply expenses and now, the threat of tariff-driven inflation. Meanwhile, bankruptcies amid smaller practices of between $500,000 and $2 million in revenue have been steadily rising in the last two to three years, said Daniel Gielchinsky, a partner at DGIM Law in Florida who specializes in bankruptcies. Between the lines: Among the disturbing trends Gielchinsky has observed are medical practices branching into med spa-like services and investing in Botox supplies and skin-tightening lasers in hopes of capturing wealthy patients seeking elective procedures. They're finding out that consumers have less disposable income than they expected, and the competition is fierce. "We had one bankruptcy where the equipment was literally unused. They didn't get a single patient in the door to do any laser treatments, but they've had this $800,000 machine they're making payments on every month," he said. Many doctors have opted to sell their practices to a health system or private equity firm. But critics say that has accelerated the corporatization of medicine and put power in the hands of for-profit entities that have raised prices and put shareholder value above patients' interests. The other side: Doctors could see up to a 3.8% increase to their Medicare payments next year under a Trump administration proposal released earlier this summer. But to maximize their reimbursements, practices would have to agree to be paid based on patient outcomes instead of the volume of services delivered. "There is a little relief on the reimbursement side coming in 2026 to help combat those headwinds," Moylan said.
Yahoo
12-07-2025
- Business
- Yahoo
Hospital, health system M&A falls in Q2 as Medicaid cuts loom: report
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. Mergers and acquisitions between hospitals and health systems were down in the second quarter compared to recent years, as impacts from new healthcare policy and trade uncertainty came into focus, according to a report by Kaufman Hall. Eight transactions were announced in the second quarter, the lowest in the quarter since at least 2017, according to the healthcare consultancy. About half of the transactions were divestitures. Hospital and health system M&A is expected to accelerate, although it 'may return at a slower pace than it fell' as the sector absorbs the impacts from federal policy changes, including cuts to Medicaid, the report said. No mega-mergers, or transactions in which the annual revenue of the smaller party exceeds $1 billion, were announced in the second quarter. That pushed the average seller size down to $175 million, 'relatively low' compared to recent year-end averages, according to Kaufman Hall. Other metrics were low, including total transacted revenue in the quarter, which hit $1.4 billion. The metric is the lowest second-quarter result since at least 2017. The next lowest quarter was 2018, which logged $3 billion in transacted revenue across deals. Hospital and health system transactions announced in Q2, 2017-2025 This embedded content is not available in your region. Still, the number of deals in the second quarter was a modest uptick from the five deals announced in the first quarter, according to Kaufman Hall. Deal numbers were probably low in the first quarter as market volatility and economic uncertainty from the Trump administration's new tariffs had a chilling effect on M&A, according to Kaufman Hall. The potential of significant cuts to Medicaid also likely dampened deals. Those cuts were realized after President Donald Trump signed a reconciliation bill in early July with over $1 trillion cuts in healthcare spending over the next decade. Most of those cuts will be concentrated in Medicaid, with providers bracing for hits to their revenue as the uninsurance rate rises. That chilling effect has consequently bled through into the first half of the year, according to the consultancy. 'Business challenges and uncertainty about federal and state policies have affected both the divestitures and affiliations we're seeing in the market,' said Anu Singh, managing director at Kaufman Hall. 'Now that some of the policy uncertainty has resolved, we expect providers will refocus their strategy and transformation efforts, which could spark greater activity in future quarters.' Recommended Reading Historic Medicaid cuts to come as Trump signs domestic policy bill Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
20-05-2025
- Business
- Yahoo
LucyRx Expands Executive Team
Strategic appointments support rapid growth with proven leadership in core operating areas BETHESDA, Md., May 20, 2025--(BUSINESS WIRE)--LucyRx, a next-generation pharmacy benefits manager (PBM) committed to simplifying and improving access to prescription care, recently added four healthcare industry veterans to expand core operations, including legal, sales and government programs as the company continues its rapid growth nationwide. With patient-focused and fairly priced pharmacy benefits in high demand, LucyRx has grown quickly, now covering more than one million members with 1,200 health plan clients across the U.S. These healthcare veterans add valuable depth to support the company's growth—as more organizations choose its member-centered, technology-driven approach to prescription benefits. Paul Brown, Chief Legal Officer and General Counsel, will oversee the company's legal strategy, compliance and risk management. Paul brings extensive experience in regulatory compliance, commercial transactions and M&A execution and integration from prior roles at Kaufman Hall (a Vizient company) and UL Solutions. Michael McCarrell, Chief Operating Officer, will lead all core operational areas including customer service, claims administration and clinical operations. Michael brings over 25 years of healthcare leadership experience, most recently as President and COO of CPS Solutions, where he led the nation's largest hospital pharmacy services provider. Crescent Moore, Senior Vice President of Government Programs, will lead LucyRx's expansion into Medicare and other government-sponsored markets. Crescent brings nearly two decades of leadership in Medicare Part D and clinical strategy, most recently as Director Part D/Pharmacy at BluePeak Advisors. Cody Field, Senior Vice President of Employer Sales, joins LucyRx with a strong background in clinical care, account management, and business development. Most recently at Marsh McLennan, Cody brings a patient-first mindset and deep healthcare experience that will further strengthen LucyRx's partnerships with employers nationwide. "Each of these leaders brings significant experience to ensure LucyRx is the most innovative, highest performing, patient-centered prescription benefit provider in the industry," said David Blair, CEO of LucyRx. "With Mike, Paul, Crescent and Cody on board, we're well positioned to bring our vision to life: prescription care, brilliantly reimagined." About LucyRx LucyRx is an independent, next-generation pharmacy benefit manager (PBM) redefining prescription care. Fueled by innovation and decades of leadership experience, LucyRx delivers better outcomes through its integrated specialty network, formulary marketplace, and next-day home delivery solutions. Powered by its proprietary AI platform, LucyIQ™, the company provides real-time insights that support evidence-based clinical decisions, clear pricing, and exceptional service from U.S.-based pharmacy technicians. Partnering with more than 60,000 pharmacies, LucyRx serves over 1,200 clients nationwide. This is prescription care, brilliantly more at View source version on Contacts Media Contact Tricia Bancroft516-241-6157press@ Sign in to access your portfolio
