Key Takeaways:
- Consumers think the U.S. health system is big business focused on making profits.
- Consumers do not understand how the system operates.
- Consumer pay more attention to their out-of-pocket costs than prices.
- Price transparency as a policy mechanism to reduce health spending needs further study.
Last week, more than 1 million federal employees furloughed or laid off went without a paycheck as the federal shutdown continued and the Bureau of Labor Statistics (BLS) reported consumer prices in September were up sparked by higher gas prices.
This week, open enrollment starts through the ACA’s Marketplaces, insurers will announce 2026 premiums for their Medicaid, Medicare Advantage, Individual and Group plans and the Federal Reserve (Fed) will meet to assess the nation’s monetary policies in light of the U.S.’ economic climate.
The thread that connects these is household finances and costs of living.
A September, the Harris poll found 40% of households have seen their monthly household expenses increase $500 to $749 and Yale Budget Lab economists predict households will see an additional increase of $191/month as tariffs kick in and the economy adjusts. In tandem, layoffs by public and private sector employers (including hospitals and tech companies) are increasing and employer benefits costs are being shifted to employees. It’s reflected in Friday’s CPI report:
Healthcare accounted for 8.3% of prices paid by households in September—far less than housing (35.5%) and food (13.6%) but more than energy (6.4%). Economists attributed a slight uptick in inflation to gas prices but the government’s data showed hospitals prices more impactful than energy over the prior last 12 months:
BLS CPI Report for September, 2025 (released 10/24/25)
| Category | Impact on CPI | September ‘25 | Sept 24-Sept 25 |
| All Items | 100% | +0.3% | +3.0% |
| Food | 13.6% | +0.2% | +3.1% |
| Energy | 6.4% | +1.5% | +2.8% |
| Shelter | 35.5% | +0.2% | +3.6% |
| Medical care commodities | 1.5% | -0.1% | +0.7% |
| Medical care services
Physician Services Hospital Services |
6.8%
1.8% 2.0% |
+0.3%
-0.1% +0.3% |
+3.9%
+2.4% +5.5% |
Consumer Price Index Summary – 2025 M09 Results
Price transparency has been imposed on healthcare since 2021 when hospitals were first required to make prices available to consumers for 300 shoppable services. Requirements for insurers followed the next year, and efforts for price disclosures for prescription drugs is prominent in the Trump administrations MAHA agenda. But so far, evidence that price transparency has impacted smarter purchasing decisions by consumers is scant. It’s understandable.
I’ve moderated focus groups annually since 1996 exploring consumer views of the health system’s performance on topics like price transparency. Their views on healthcare prices are rooted in four pre-dispositions:
1-The average household is worried about higher prices and their ability to survive financially. The majority expect their costs of living to increase due to inflation and spending for necessities pinched. Healthcare is considered a necessity, but food, shelter, transportation, and child care more important.
2-The average household is concerned about health costs and believes they’re neither predictable or reasonable. There’s consensus that the “system” is complicated, healthiness a matter of luck and genetics and “profit” the primary interest of the system. The “corporatization” of the system is seen as a negative associated with higher prices and fewer choices.
3-The average household does not understand how the health system operates but believe it profitable. There’s general agreement that insurers, drug companies and hospitals are responsible for increased health costs, verifiable prices should be transparent and accessible and executive compensation excessive. And there’s recognition that prices for most services are purposely inaccessible to patients (consumers).
4-The average household wants a better health system that accessible, affordable and navigable but they’re unfamiliar with alternatives that could be considered. Most prefer a private system that’s comprehensive, connected and personalized to individual needs. Ideally, a system of health which makes its prices readily accessible.
My take
Efforts to activate consumer attention to healthcare prices is very much a work in process despite significant policy efforts toward price transparency for drug prices and hospital “shoppable” services. To date, results have been modest.
Might that change? That’s the question Boards and C Suites across the health continuum must answer. Insiders think it’s unlikely; outsiders hope they’re wrong. If price transparency is the pre-cursor improved value in healthcare spending for most services, the proof is lacking to date.
Do Consumers Care about Healthcare Prices (Really)? Some do. More will. And all say it’s important. But until and unless price comparison becomes a staple in American household spending behavior, little will change.
Paul
PS: As road warriors know, the friendly skies are no longer. Thursday, my return from WellSpan’s Board Retreat in PA to Asheville began uneventfully at 4:45 a. m. and ended at 7 p.m.—9 hours later than my scheduled arrival. What started as a mechanical delay for a 6:36 a.m. departure from Harrisburg (AA 6070) was followed by a cascade of “mechanical delays” and standby disappointments that became laughable, even when gate agents boarded NON-REV travelers (off duty crew) explaining to me later flights were available. And using other carriers was out of the question though they said a credit could be issued if I chose to go downstairs to the Delta ticket counter and start over.
Like healthcare, frontline workers take the heat when policies and procedures fall short. While C suites are under pressure to operate profitably, frontline teams absorb the hits. I found myself reflecting on our frontlines who experience the same every day and have written commendation letters to AA for the “above and beyond” help I got from the Charlotte service desk that got me home eventually.
There should be awards for frontline exceptionalism in healthcare!!
Sections in today’s Report: Citations from Last Week in U.S. Healthcare
- Quotables
- Corporate Healthcare Announcements
- Economy
- Employers
- Hospitals
- Insurers
Quotables
Washington Post on Insurance Premium increases: “Average Obamacare premiums are set to rise 30%, documents show. The rise in prices — affecting up to 17 million Americans who buy coverage on the federal marketplace — are by far the largest annual premium increases in recent years. The higher premiums, along with the likely expiration of pandemic-era subsidies, mean millions of people will see their health insurance payments double or even triple in 2026.”
Average Obamacare premiums set to increase by 30 percent – The Washington Post
Modern Healthcare Recap of 8th Health Expo: “HLTH 2025 is in the books, and many attendees will likely need a detox from the words “artificial intelligence.” Here are six takeaways from HLTH.
- Most provider and insurance executives…were confident that ambient listening technologycould make clinicians’ lives easierand improve patient-physician interactions by automating documentation. Despite their confidence, executives said the emerging technology needs refining and warrants caution.
- Beyond ambient AI-assisted documentation, many vendors at HLTH showcased tools designed to help providers and payers get paid faster and streamline revenue cycle management
- The government shutdown has throttled some revenue streams, causing unease and unexpected speaker absences during the conference
- The healthcare industry is steeling itself for what’s likely to be the largest projected rise in healthcare costs in at least a decade.
- Despite efforts by pharmaceutical and digital health companiesto lower the price of the drugs through direct-to-consumer business models, GLP-1s are hitting employers hard.
- Providersare trying to better control their costs throughAI-powered technology that promises to reduce burnout, refine clinical care and improve training programs.”.
HLTH 2025 recap: Ambient AI, GLP-1 costs, government shutdown – Modern Healthcare
Related: Hospitalogy on HLTH: “HLTH’s greatest strength is its ability to bring a large swath of people together to connect across the healthcare innovation ecosystem, and the access to innovation leaders is fantastic for folks like me. But overall, the conference felt a little sleepy this year and I wasn’t the only one to feel this way. I don’t think it’s a knock on the conference or its production – that remains top tier and absolutely fantastic. Rather I think it traces back to a desire for folks to find more intimate spaces for better dialogues, and this dynamic doesn’t happen on a big stage.
Plus, with budgets tighter in 2025 and the government shutdown, I would imagine these dynamics led fewer employers, payors, health system, and gov’t folks to come out. Really unfortunate. HLTH is great at what it does and I’ll be interested to see how it continues to evolve to match this changing tide in the healthcare conference game.”
Articles – Hospitalogy October 23, 2025
Trilliant on healthcare doom loop: “The U.S. healthcare system is caught in a doom loop of self-reinforcing dynamics that drives costs upward, health outcomes downward and makes reform increasingly difficult.
Healthcare spending continues to outpace inflation and wage growth even as employers, government and households face growing financial strain. Instead of innovation or transformation, payers respond with ever-increasing premiums and deductibles, while providers seek higher commercial rates to offset reimbursement pressures from government payers and patients delay or avoid care due to affordability concerns.
Each stakeholder defends its revenue model, also known as maintaining the status quo. The result: costs continue to rise, access worsens, health outcomes stagnate and resources are allocated inefficiently. Together, this exemplifies a negative-sum game in which all participants expend more and collectively gain less.
The trajectory of healthcare reform hinges on whether change is pursued proactively from within the system or imposed externally through government intervention.”
P.11 The Summit 2025 Takeaways Trilliant Health www.trilliant.com
Patient social media comment on hospital price surprise: “I know the health care system is broken and prices are through the roof. I wanted to see if what I’m seeing is consistent with others experiences. I fell in August and broke my foot and arm. The Arm required a ORIF surgery. I had an outpatient surgery at the Advent main hospital. I reviewed my class to my insurance yesterday and I was speechless. I saw the doctor’s surgical fee’s which were very reasonable around 4k and a couple thousand for anesthesia. When I got to just the facility fee’s I nearly fainted. For a 2 hour outpatient surgery on a non-complicated patient my insurance was billed just over 72k. Is this actually the running rate for surgery facility fee’s these days. Shoot if I add both bills from both my child births and a 1 week stay in the Nice for one kiddo it still was lower than this 2-hour outpatient surgery.”
Business Insider on shutdown: “The federal government shut down on October 1. At 22 days long, that’s less than two weeks shy of the longest-ever shutdown that stretched from December 18, 2018, to January 25, 2019.
On Thursday, odds on Polymarket showed that bettors think the latest shutdown will be the lengthiest on record. A wager with almost $2 million in volume shows 40% of bettors think it will last until November 16 or later. After that, 16% believe it will go until November 4-7, and 13% see it lasting until November 13-16.
Bets on Kalshi also show that users expect the shutdown to continue well into November. Betting volume has reached $16,383,303, and bettors see a 77% chance that it will exceed 35 days, lasting until November 15. Odds that it will last at least 40 days are currently at 56%.”
The Government Shutdown Will Drag into November, Betting Markets Predict – Business Insider
Health Affairs on price transparency: “Price transparency is a prerequisite for a functional market in any industry. In health care, it can allow patients to select services at a reasonable price. For purchasers such as group health plans, it can improve provider network selection and enable employers and unions to be better stewards of their employee health care funds and to monitor prices negotiated on their behalf by insurers. Price transparency can also improve the ability of regulators and policy makers to ensure competitive health care markets.
After four years, federal price transparency rules have revealed a meaningful number of prices. But they’ve revealed something more: immense complexity, and costly inefficiencies. in health care financial practices such as payer-provider contracting, pricing, billing, repricing, and payments…
Price transparency is part of the essential foundation for a functional market in health care services. However, to achieve the goals of the policy, researchers and policy makers should more comprehensively examine the high cost we pay—individually and nationally—for the exquisitely complex systems and practices currently used in contracting, pricing, billing, claims repricing, and payment processing for health care services. In addition, complementary state and/or federal legislation that prohibits anticompetitive obfuscation or nullification of prices will considerably accelerate the gains to be realized from price transparency.”
New York Times on October 20 AWS system shutdown: “It doesn’t take much to crash the internet anymore. In this case, it was a glitch at Amazon Web Services…
Meltdowns like these are possible only because the internet is more interconnected than ever. Thousands of companies use the same third-party programs (like CrowdStrike) and send their data to the same third-party cloud providers (like AWS)…
With infrastructure concentrated among just a few big players that seem to prioritize profit over security, users are vulnerable. An issue at a single one, in a single location, can paralyze the economy.”
CNN on potential Tylenol labeling change: “Kenvue, the American company that makes Tylenol, is pushing back against an FDA proposal to change the painkiller’s safety label. The updated label would mention a possible link between Tylenol use during pregnancy and diagnoses of autism or ADHD in children. Many credible health experts agree that the science does not support that claim, even as the Trump administration calls for tougher warnings. Kenvue also says that acetaminophen, the generic name for the painkiller and fever reducer, is “one of the most studied medicines in history” and that “adoption of the proposed labeling revisions would be arbitrary, capricious, and contrary to law.”
5 Things am October 21 www.cnn.com
Axios on drug price controls: “Whatever political opposition existed around restricting pharmaceutical prices via government intervention — and there was quite a lot not so long ago — seems to have largely disappeared. In other words, price controls are all the rage.
Why it matters: As most Republicans fall in line behind President Trump’s efforts to take on drug prices, the new conversation is around how to limit costs through policymaking, not whether to.
Between the lines: Very few drugs are actually subject to government cost controls, and the Trump administration’s “most favored nation” deals have largely consisted of voluntary pricing concessions by manufacturers. But the vanguard of politicians willing to defend free market pharmaceutical pricing has drastically shrunk. The outcasts argue that top-down cost controls have unintended consequences, the worst of which will be a decrease in future biomedical innovation…
The bottom line: Though free market-loving, competition-embracing wonks still exist, they’re out of step with the times. “I’m in favor of trying capitalism,” Holtz-Eakin said. “I don’t see any appetite for it in the White House.”
McKinsey on Gen Z: “Gen Z is here. As a generation, they are established, fast growing, and fast changing. This is a critical moment in time: Gen Z’s average age now is 22. They range in age from 15 to 29. Since last year, there’s been a 45% increase in Gen Zer’s who are saying they’re married, a 23% increase in those with children. And 19 percent of Gen Zer’s are in decision-making roles at work.
This generation is fast gaining spending power. They view money differently from generations before them: They care a lot about financial security, but they are willing to splurge—and to splurge quite a bit more than generations before them. We don’t see any sign of that slowing down. We are seeing some shifts in areas that prior generations considered big investments, such as home purchases. Gen Z is investing quite a bit in experiences rather than things. They’re also spending on micro experiences—they’re willing to pay for the cup of coffee that brings them joy at the beginning of the day, or they’re willing to invest in nutrition, which they view as important.”
Consumer sentiment & behavior trends in 2025 | McKinsey
Gostin on MAHA dismissals: “Summary dismissals of scientific advisors are harmful to public health and the environment. Long-serving committee members accumulate deep subject matter knowledge, historical context, and relationships across agencies. Most of the administration’s new appointees have little expertise in vaccines, immunology, epidemiology, or public health, and many of them have alarming records of vaccine denial. Scientific advisory committees typically work through rigorous and transparent data review and peer discussions. But now, ACIP is failing to publish its agenda, neglecting scientific review, and even limiting CDC scientific input. This is all unlawful, but don’t expect the Supreme Court to defend science and the rule of law.
Overall, we have seen an erosion of credibility and public trust in scientific recommendations. Never before, for example, have major medical organizations and consortia of states issued vaccine recommendations at odds with ACIP and CDC. Advisory committees serve as independent checks on agency decisions. Removing committee members en masse concentrates power in the HHS Secretary, who is using it for political ends.”
Lawrence O. Gostin, JD, is university professor in Global Health Law at Georgetown University, faculty director of the O’Neill Institute for National and Global Health Law, and director of the World Health Organization (WHO) Collaborating Center on Public Health Law and Human Rights.”
Corporate Healthcare announcements October 18-25, 2025
Ensemble Health has hired JPMorgan and Goldman Sachs for a sale or IPO early next year. The PE-backed healthcare company is aiming for a $13 billion valuation in the deal. “Ensemble Health is booming as investors bet on AI tools to boost hospital revenue…”Tech has enjoyed a number of blockbuster VC-backed IPOs this year, from Figma to Klarna.Venture-backed Hinge Health and Omada Health both made their public market debuts earlier this year, after Business Insider first reported their IPO plans in mid-2024.”
Ensemble Health Hires JPMorgan, Goldman Sachs for a Sale or IPO – Business Insider
Elevance Health: The insurer announced it will impose penalties (10% of allowable claims) and potential termination on hospitals and doctors that allow out-of-network providers to participate in care for its members. The policy applies to Anthem Blue Cross Blue Shield commercial plans in 11 states and begins Jan. 1. Notably, providers s is not permitted to pass the cost of administrative penalties on to patients. Elevance Health beat Wall Street estimates for third-quarter profit as the health insurer managed to keep medical costs in check, sending its shares more than 7% higher in premarket trading.
Elevance beats profit estimates as health insurer keeps costs in check
HCA: Nashville, Tenn.-based HCA Healthcare reported a net income of $1.6 billion (8.6% margin) in the third quarter, a significant improvement on the $1.3 billion net income (7.3% margin) posted in the third quarter of 2024.
For the nine months ending Sept. 30, 2025, HCA reported a net income of $4.9 billion (8.7% margin) compared to $4.3 billion (8.3% margin) in the prior-year period. HCA’s third-quarter revenue increased 9.6% year over year to $19.2 billion.
HCA raised its full-year 2025 financial guidance:
- Revenue: revised to $75 billion to $76.5 billion, up from $74 billion to $76 billion.
- Net income: increased to $6.495 billion to $6.715 billion.
- Adjusted EBITDA: now expected to be $15.250 billion to $15.650 billion.
- Earnings per share (diluted): raised to $27 to $28 per share.
HCA Healthcare raises annual forecasts on robust medical care demand | Reuters
Hologic: Blackstone and TPG announced an agreement to buy Marlborough, Mass.-based medical device maker Hologic (Nasdaq: HOLG) for up to $18.3 billion (including debt). Hologic, which is known for breast and cervical cancer diagnostics, had rejected a nonbinding $16.7 billion bid from Blackstone and TPG back in May. The two sides reportedly reengaged after Labor Day.
Dark Daily October 24, 2025 https://www.darkdaily.com/2025/10/24/hologic-goes-private-in-18-3b-sale-to-blackstone-and-tpg-amid-diagnostics-shake-up/
Cost Plus Drugs and TrumpRx: During an onstage session at HLTH, Mark Cuban revealed a forthcoming partnership between his Cost Plus Drugs company and TrumpRx, a federal program designed to bring discounted prescription drugs directly to consumers. TrumpRx, which is set to launch early next year, will function as a referral platform, directing people to websites like Cost Plus Drugs. Through this partnership, Cost Plus Drugs will provide its pricing data to TrumpRx. Cuban said he hopes this collaboration will disrupt the traditional PBM model, which he has long criticized for contributing to the nation’s exorbitant drug prices.
7 HLTH Announcements You Don’t Want to Miss – MedCity News
Economy
Quartz on CPI Report: The consumer price index rose 0.3% on a seasonally adjusted basis last month, the Bureau of Labor Statistics reported Friday, after a 0.4% gain in August. The data release came after a delay caused by the federal government shutdown, which has left policy makers, economists and businesses to operate without the usual steady release of government economic data.
Annual inflation in September hit 3% from a year earlier, the fastest pace since January and broadly in line with economists’ surveyed by Dow Jones. Core CPI, which excludes food and energy, climbed 0.2% in September and was running 3% higher than a year ago…
Friday’s report is also a crucial barometer for how President Donald Trump’s tariffs are impacting prices. Polls show voters view inflation as their biggest economic concern, with Trump’s approval on the issue falling below 30% …”
Inflation rose to 3% in September, CPI shows in delayed release
Social Security: Retirement and disability benefits for 2026 will increase by 2.8%, a $56-a-month boost for retirees starting in January vs. 2.5% last year. The cost-of-living adjustment (COLA) affects more than 75 million recipients of Social Security retirement and disability benefits.
Social Security paper checks end Sept. 30 in move to direct deposit
Bloomberg on SPACs: “Only about 11% of companies that have gone public through a SPAC merger since 2019 are trading above their issue price, and dozens went bust just months after listing on US stock exchanges. Meanwhile, since the end of 2018, the S&P 500 has more than doubled and the Nasdaq 100 has almost tripled.”
Bonds Face ‘Tipping Point’ as Inflation Data Finally Arrives – Bloomberg
Employers
KFF 27th Annual Employer Health Benefits survey results: “Employer-sponsored health insurance is the largest source of cover-age in the United States, covering more than 154 million nonelderly people in 2023…
Average annual premiums in 2025 were $9,325 for single coverage and $26,993 for family coverage. The single premium increased by 5%, and the family premium increased by 6% from last year. By comparison, inflation rose 2.7% and wage growth increased 4%. Over the course of the past five years, the average premium for family coverage has risen from $21,419 to $26,993—an increase of 26%, which is roughly in line with inflation (23.5%) and wage growth (28.6%). In recent years, the economy has experienced high general inflation. Since 2020, inflation has risen by 24%, which is higher than the 10% increase seen between 2015and 2020 or the 8% increase seen between 2010 and 2015. Over the past five years, family premiums have risen by 26%, similar to the rates of inflation at 23.5% and wage growth at 28.6%. Workers’ pays toward family premiums has grown by 23% over the same period.
Nearly one in five (19%) large firms offering health benefits covered GLP-1 agonists when used primarily for weight loss. Many employers reported concern about out-of-pocket spending: 45% of firms offering health benefits indicated that their employees had a “high” or “moderate” level of concern about the affordability of cost sharing. 36% of large firms offering health benefits reported that prescription drug prices contributed “a great deal” toward “premium increases….
PK Note: In total, 1,862 firm’s benefits managers completed the full survey (13% response rate). KFF defines small firms are those with 10–199 workers, and large firms are those with 200 or more workers. These findings are weighted toward small and mid-sized employers and may not accurately reflect the broader commercial private market where large multi-nationals and gig economy workers are not captured.
Health Benefits In 2025: Family Premiums Rise 6 Percent, Large Employers Increase Coverage Of GLP-1s For Weight Loss | Health Affairs October 22, 2025
Study: Employer-sponsored healthcare spending in 2022: The health care claims of 13.1 million individuals with employment-based health benefits in 2022 were examined using the MarketScan. Findings:
- “Overall, 18% was spent on inpatient services, 51% on outpatient services, and 31% on prescription drugs.
- Inpatient Services: As health care spending increased, the proportion allocated to inpatient services significantly rose. For enrollees with under $50,000 in spending, inpatient services represented only 9% of their total health care expenditure. This jumped to 58% for those with $2 million or more in spending.
- Outpatient Services: Conversely, outpatient services accounted for a decreasing share of health care spending as total spending increased. They made up 67% of spending for enrollees under the $50,000 threshold, but this dropped to 20% for those with $2 million or more in spending.
- Prescription Drugs: For enrollees with under $50,000 in total health care spending, prescription drugs constituted 24% of their expenditure. This percentage rose to 41% for those spending $50,000 or more, $100,000 or more, and $250,000 or more.”
Unlocking Health Benefits: Where Employer High-Cost Spending Often Goes ff-547-highcost4-23oct25.pdf
ERI: Labor market: “Actual compensation movement in the third quarter of 2025 saw a growth rate of 0.48%, which is lower than growth rates reported in July 2025 (0.57%), April 2025 (0.63%), and January 2025 (0.60%). Annual growth in the third quarter of 2025 slowed to 2.27% from the 2.38% annual growth rate reported in July. Current growth is also lower than the 2.66% annual growth rate reported in April and the 2.82% rate published in January. This rate of growth has decreased from the high of 4.14% in 2022. Turning to the labor market, current data indicate a softer market than 2024, but one that has been largely unchanged since last quarter. An examination of the current number of job openings indicates a high number of open jobs in the United States, with an open job rate of 4.3%, which is below than the 10-year average open job rate of 4.9%. It is also down significantly from the high of 7.3% in March 2022. The rate of hires is currently 3.3%, which has been slowly trending down since the high of 4.4% in March 2022. This gives us a current gap between open jobs and hires of 1%, which is higher than last quarter’s gap of 0.9% and below its highest point of 2.9% in March 2022. The 15-year gap between hires and open jobs is 0.54%, so the gap between hires and open jobs remains above average. “
National_Compensation_Forecast_October_2025.pdf
Hospitals/Health Systems
Bain on primary care strategy: “Primary care is a critical and growing pillar of health system strategy. In a recent Bain survey, 77% of health system executives said they plan to expand their footprint by adding more practices and employing more primary care physicians in the next five to seven years.
Why? Patient outcomes remain paramount, as leaders recognize that primary care is essential to delivering consistent, high-quality care. Beyond improving clinical outcomes, however, the rationale for expansion reflects a strategic shift. Health systems are moving away from prioritizing primary care as an engine for referrals and ancillary revenue, instead focusing on its role in cost management and the patient experience.”
Why Health Systems Are Expanding Primary Care | Bain & Company
Fitch Report on NFP Hospital Financial Stability 10/23/25: Excerpts: “A sharp equity market correction would cause a drop in liquidity for Fitch-rated U.S. not-for-profit (NFP) hospitals as investment income comprises a growing share of hospitals’ liquidity positions and revenue, Fitch Ratings says. Nevertheless, we believe credit effects would be limited, as hospitals in our rated portfolio maintain substantial unrestricted liquidity despite significant operating pressures over the past few years…
Most rated hospitals are able to manage a normal cyclical market correction without affecting ratings due to their strong baseline liquidity levels and ratings headroom afforded by Fitch’s forward-looking stress case scenario testing…
Large investment return declines would erode balance sheet strength and may compromise hospitals’ ability to address mounting challenges. These include a tight healthcare labor market, potential reductions in ACA marketplace subsidies if Congress does not extend the enhanced credits, and the impact of higher tariffs, as well as reduced federal Medicaid spending, tighter Medicaid eligibility, and limits on state provider taxes beginning in 2026.
In general, Fitch-rated NFP hospitals have strong liquidity relative to debt obligations, and their balance sheets compare favorably to pre-pandemic historical averages, partly due to strong overall market gains over the last three years…
In 2024, investment income grew as a share of total revenue for investment-grade-rated hospitals… As a share of EBITDA, investment income climbed to 28.1%, the highest it has been in the last five years. Investment returns also contributed 19.9 days to days cash on hand (DCOH) and 15.5 percentage points to cash-to-debt in fiscal 2024, compared with contributions of 16.2 days and 12.1 percentage points, respectively, in fiscal 2023…”
Not-for-Profit Hospital Liquidity Strength Limits Market Bubble Risk
Comparisons of Medicare Beneficiaries Cared for in Hospital Outpatient Departments (HOPD) and Independent Physician Offices (IPO): Relative to beneficiaries seen in IPOs, beneficiaries seen in HOPDs are:
- 54% more likely to be under 65 and Disabled
- 61% more likely to be dual eligible
- On average, from lower income areas (median income for HOPD: $76,086; IPO: $81,243)
- 60% more likely to live in a rural county
- More likely to have least one chronic condition (57% for HOPD vs 48% for IPO)
- Have higher prior emergency department use (0.45 mean number of ED visits for HOPD vs 0.21 for IPO)
- Have a higher percentage of visits with a prior inpatient hospital stay (15% for HOPD vs 7% for IPO)
American Hospital Association, Comparison of Care in Hospital Outpatient Departments and Independent Physician Offices, September 2025
Ballad Health v. -UnitedHealth lawsuit filed: Ballad Health—a 19 hospital NFP system in mostly rural East Tennessee—filed suit against UnitedHealth Group: “The system alleges that UnitedHealth has systematically denied, delayed or underpaid for care that physicians determined to be medically necessary, while also overstating to the federal government how sick its members are to collect higher taxpayer-funded payments through the Medicare Advantage program.” The suit sees punitive damages in addition to payments in arrears.
Ballad Health Sues UnitedHealth Group | Ballad Health
Study: Private equity ownership of hospices: “Private equity (PE) firms and publicly traded companies own a growing share of US hospices, but little is known about differences in financial outcomes among for-profit hospices. Using 2022 Medicare cost reports, researchers analyzed revenue and expense data across four hospice ownership models: PE-owned, publicly traded company–owned, other for-profit, and not-for-profit. Findings:
“Compared with for-profit models, not-for-profit hospices spent substantially more on direct patient care, driven by differences in nursing salaries. Relative to publicly traded company–owned and other for-profit hospices, PE-owned agencies reported the highest profits and lowest spending on direct patient care and nonsalary administrative services. PE-owned hospices also reported significantly greater expenses and revenues related to nursing facility room and board compared with all other ownership models.
Our findings suggest that PE-owned hospices may follow distinct operational strategies, emphasizing nursing facility–based care and administrative efficiency while limiting direct patient care investments. Reduced spending on patient care may undermine hospice quality and shift costs to other areas of the health care system. To promote Medicare savings and better align payment with care delivery costs, policy makers could consider modifying the per diem model of hospice payment to reduce reimbursement when beneficiaries are co-located in nursing facilities. “
Insurers
OIG Study: MA Network adequacy: “This review assessed the extent to which selected plan networks were limited and whether the providers listed in each directory were actively providing services to the plan’s enrollees.
Many Medicare Advantage and Medicaid managed care plans had limited networks of behavioral health providers. These provider networks were further limited by including inactive providers who did not provide any services to enrollees (72% were inactive). Most of these inactive providers should not have been listed as network providers by the plan. For example, these providers no longer worked at any of the locations listed by the plan or they indicated they would not see patients enrolled in the plan. These inactive providers are sometimes referred to as “ghost” providers and can make the networks appear larger than they are. Providers cited administrative burden and low payment rates as factors affecting their willingness to work with managed care plans
Roughly 3 out of every 10 Americans are covered by a Medicare Advantage or Medicaid managed care plan. In 2024, 32.8 million people, or more than half of all Medicare enrollees, were enrolled in a Medicare Advantage plan.3 In Medicaid, more than 83 million enrollees were enrolled in a managed care plan, with most States providing the majority—if not all—of their behavioral health services through managed care.”
Physicians
Study: Pricing differences by practice ownership: “Hospital and private equity (PE) consolidation in health care is altering the physician practice landscape, with more than three-quarters of physicians employed by these corporate entities as of 2023… in 2023, the majority of specialists (approximately 72% of cardiologists and 57% of gastroenterologists) were employed by hospitals, whereas PE-affiliated specialists constituted a lower share and were concentrated in certain geographic regions. Hospital-affiliated specialists negotiated prices that were 16.3% higher for cardiology procedures and 20.7% higher for gastroenterology procedures compared with specialists in independent practices. PE-affiliated specialists negotiated prices that were 6.0% higher for cardiology and 10.0% higher for gastroenterology procedures. If hospital- and PE-affiliated specialists charged prices equivalent to those of independent practices, commercial health care spending would decrease by approximately $2.9 billion and $156 million, respectively. As corporate consolidation of physician practices continues to accelerate, greater antitrust enforcement and enhanced transparency in ownership structures and pricing will be essential tools for policy makers to use in containing health care costs while preserving patients’ access to high-quality specialty care.”
Study: Physician participation in Medicare: Researchers analyzed physician participation in the Medicare program between 2013 and 2023 and determined whether physician- and county-level factors were associated with program exit (i.e., no longer caring for Medicare patients) Results:
“Between 2013 and 2023, there were 11.6 billion claims for physician services from more than 960 000 unique physicians. Over this time, the number of physicians participating in the Medicare program increased by 6.3%, from 585 642 to 622 342, with differing trends in numbers by physician age, sex, specialty, and metropolitan location and HPSA status.”
Study: Primary care production: Researchers analyzed 33 clinics in the Mass General Brigham health system involving 406 attending PCPs who delivered care for at least 9 months in 2021. Results:
“The median work effort for a full-time PCP was 2844.3 yearly hours or 61.8 weekly hours for a 1.0-cFTE physician assuming a 46-week work year. This translates to a median of 1.7 hours per patient per year. Part-time PCPs spent more time per patient on average than full-time PCPs. Patient medical advice request volume and certain panel characteristics, including greater average age, medical complexity, and percentage of patients with Medicaid, were associated with greater yearly PCP time expenditure per patient.”
Beckers on physician comp (10/22/25): Excerpts: “Physician and healthcare CEO pay continues to climb. And for physicians, growing pay disparities, steep proposed Medicare cuts and years of inflation-adjusted declines, are reshaping how much physicians really take home.
- Median base salaries for healthcare executives climbed7%, up slightly from 4.6% the previous year, according to a survey by Sullivan Cotter. System-level executives saw a 5.2% increase, higher than the 4.7% increase for leaders at subsidiary hospitals.
- A Rice University Baker Institute studyfound that inflation-adjusted CEO pay at nonprofit hospitals increased significantly between 2012 and 2019. Average CEO compensation rose 34%, from about $1 million to $1.3 million, with higher pay linked to larger and more profitable hospitals. During that same period, registered nurses’ salaries grew only 2.3%.
- The pay gap betweenCEOs and average employees at U.S. nonprofit hospitals widened from 2009 to 2023, according to a Health Affairs study.
- Average CEO pay increased 27.5%.
- Top executive pay rose 23.1%.
- The average wage for all hospital employees, executives included, increased just 9.8%.
- Inflation-adjusted annual CEO pay rose from about $814,000 in 2009 to $1.04 million in 2023.
- A Sullivan Cotter found that physician’s median total cash compensation — base salary plus incentives — grewfaster than it has in a decade…Adult medical specialties saw the largest year-over-year gain at 7.5%. Over five years, primary care specialties have led with a 21.8% total increase.
- According to the American Medical Association, when adjusted for inflation, Medicare physician payment has effectively declined33% from 2001 to 2025. Some specialties may face steep reductions. For example, oncology, internal medicine, OB-GYN and infectious disease may stand to see at least 5% cuts or more under certain proposals.
Physician vs. healthcare CEO pay: 10 breakdowns – Becker’s Physician Leadership
Public Health
Public Health Journal announced: “In the latest bid to plug gaps in the federal government’s public health infrastructure, two institutions are coming together to create an alternative to the Centers for Disease Control and Prevention’s vaunted Morbidity and Mortality Weekly Report — often called “the voice of the CDC.”
The New England Journal of Medicine and the Center for Infectious Disease Research and Policy will begin publishing “public health alerts” in the coming month, CIDRAP Director Michael Osterholm announced at the IDWeek conference on Sunday…
A spokesperson for NEJM said the alerts would be published in a new section of its NEJM Evidence journal as needed — as opposed to being published on a weekly basis — and be made available for free…”
Institutions move to provide data now found in CDC MMWR journal | STAT
