UNHAPPY HOSPITALS: One Big Beautiful Bill Act!

Posted on July 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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One Big Beautiful Bill Act (OBBBA; OBBB; BBB), or the Big Beautiful Bill, is a budget reconciliation bill in the 119th US Congress.

Hospitals are not happy with the health care provisions of the bill, which would reduce the support they receive from states to care for Medicaid enrollees and leave them with more uncompensated care costs for treating uninsured patients.

“The real-life consequences of these nearly $1 trillion in Medicaid cuts – the largest ever proposed by Congress – will result in irreparable harm to our health care system, reducing access to care for all Americans and severely undermining the ability of hospitals and health systems to care for our most vulnerable patients,” said Rick Pollack, CEO of the American Hospital Association.

The association said it is “deeply disappointed” with the bill, even though it contains a $50 billion fund to help rural hospitals contend with the Medicaid cuts, which hospitals say is not nearly enough to make up for the shortfall.

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DAILY UPDATE: AHA as Stocks End Slightly Mixed

Posted on June 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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Stat: $18 billion. One report says that’s how much hospitals and health systems spent combating workplace violence in 2023. (the American Hospital Association)

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🟢 What’s up

  • The trading platform eToro rose 10.58% and touched a record high after analysts began coverage of the stock. They generally had nice things to say.
  • Aviation startups like Archer (+10.50%), Joby (+13.67%), Vertical Aerospace (+15.24%), and Blade Air Mobility (+11.58%) all popped after President Trump signed an executive order on Friday intended to spur drone manufacturing.
  • Stablecoin issuer Circle can’t stop won’t stop after its IPO last week, popping another 7.24% for its third straight day of gains.
  • Topgolf Callaway jumped nearly 15% after a board member bought ~$2.5 million worth of shares last week. Just in time for the US Open.

What’s down

  • Robinhood (-1.98%) and AppLovin (-8.21%) fell after S&P Dow Jones Indices decided not to include them—or anyone else—in the S&P 500 index.
  • Intuitive Surgical sank 5.55% after getting its first “sell” rating on the Street from Deutsche Bank analyst Imron Zafar, who argued that the medtech company is going to face some cutthroat competition over the next few years.
  • EchoStar, a satellite and wireless company, dropped 8.52% after the WSJ reported it was considering filing for chapter 11 bankruptcy.
  • The Children’s Place tumbled 32.22% after a rough earnings report for the kids’ clothing store: It posted a quarterly loss nearly 3x projections and revenue decreased 10% year over year.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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DAILY UPDATE: Healthcare Costs, Lobbyists and Private Equity as Technology Drowns

Posted on July 31, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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In the second quarter, 14 healthcare organizations spent more than a million dollars lobbying the federal government for healthcare policy change, led by the American Hospital Association and AARP.

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Sen. Ed Markey (D-Massachusetts) and Rep. Pramila Jayapal (D-Washington) introduced strengthened legislation to rein in the actions of private equity firms that invest in healthcare facilities. The Health Over Wealth Act would require PE firms to put out reports on the facilities’ pay of executives, set up escrow accounts and receive a license from the Department of Health & Human Services prior to investing in healthcare facilities.

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The Federal Open Market Committee (FOMC) meeting ending tomorrow is widely expected to conclude with no interest rate move. Instead, it could serve as a platform to help prepare market participants for a possible cut at the September meeting.

Here’s where the major benchmarks ended:

  • The S&P 500® (SPX) index lost 27.1 points (–0.5%) to 5,436.44; the Dow Jones Industrial Average® ($DJI) climbed 203.4 points (0.5%) to 40,743.33; the NASDAQ Composite®($COMP) fell 222.78 points (–1.3%) to 17,147.42. 
  • The 10-year Treasury note yield (TNX) dropped about two basis points to 4.14%.
  • The CBOE Volatility Index® (VIX) jumped to 17.77, not far below last week’s highs.

What’s up

  • Paypal popped 8.59% after announcing impressive earnings and proving it’s got nothing to fear from Apple’s moves into the online payment world.
  • JetBlue Airways soared 12.31% thanks to a surprise profit last quarter rather than the loss analysts expected.
  • Affirm Holdings rose 2.31% due to an upgrade from “neutral” to “buy” from Bank of America analysts.
  • Tenable Holdings surged 9.30% after the cybersecurity company made it clear it’s willing to take acquisition offers.
  • F5 jumped 12.99% thanks to a beat-and-raise earnings report.

What’s down

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Visualize: A key measure of employer healthcare costs is poised for its biggest annual increase in more than a decade as more people use mental health care and get prescriptions for new, expensive drugs—yes, including Ozempic—according to a new PwC report.

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DAILY UPDATE: Squarespace, Ark Invest & Hospitals as the Markets Rebound

Posted on May 15, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 25.26 points (0.5%) to 5,246.68, the highest since a record close March 28; the Dow Jones Industrial Average® ($DJI) gained 126.60 points (0.3%) to 39,558.11; the NASDAQ Composite climbed 122.94 points (0.8%) to 16,511.18.
  • The 10-year Treasury note yield (TNX) fell more than 3 basis points to 4.449%.
  • The CBOE Volatility Index® (VIX) decreased 0.18 to  13.42.

Among companies, Home Depot’s (HD) quarterly results reported earlier Tuesday kicked off the unofficial start of the retail earnings season. The home improvement retailer’s earnings topped expectations, but revenue missed forecasts, initially sending the company’s shares down sharply. 

Home Depot also reaffirmed its full-year guidance for a 1% decline in comparable-store sales and a 1% increase in total sales. The company’s shares bounced back to end with a 0.1% loss.

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And, the Cathie Wood-led Ark Invest just made some significant trades. The most prominent among them were the increased stakes in Palantir Technologies Inc (NYSE PLTR) and the reduced holdings in Coinbase Global Inc (NASDAQ: COIN).

Moreover, the website-building platform Squarespace is to go private, which it announced it’ll be doing in an all-cash deal with Permira, a private equity firm. Squarespace, which was public for nearly three years, joins a group of other smaller tech companies like Qualtrics that have recently pulled themselves off the public market. (CNBC)

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Employers and private insurers are paying hospitals more for inpatient and outpatient services than in previous years, a study from RAND Corporation finds. The American Hospital Association dismissed the report saying it offers a “skewed and incomplete picture.”

And finally … Kaiser Permanente began its 2024 earnings season with more than $2.7 billion in net income and $935 million in operating income, just months after sharing plans to lay off workers.

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Physician Electronic-Mail Bills

Posted on May 15, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

“MY CHART”

By AMANDA SEITZ

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E-Mailing your Physician may Cost You like Your Attorneys!

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WASHINGTON (AP) — The next time you message your doctor to ask about a pesky cough or an itchy rash, you may want to check your bank account first — you could get a bill for the question.

Hospital systems around the country are rolling out fees for some messages that patients send to physicians, who they say are spending an increasing amount of time poring over online queries, some so complex that they require the level of medical expertise normally dispensed during an office visit. Patient advocates, however, worry these new fees may deter people from reaching out to their doctor and that they add another layer of complexity to the U.S. health care system’s already opaque billing process.

“This is a barrier that denies access and will result in hesitancy or fear to communicate and potentially harm patients with lower quality of care and outcomes at a much higher cost,” said Cynthia Fisher, the founder of Patient Rights Advocate, a Massachusetts-based nonprofit that pushes for hospital price transparency.

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The explosion of telehealth over the last three years — driven by the COVID-19 outbreak and relaxed federal regulations for online care — prompted many doctors to adopt more robust telecommunication with their patients. Consultations that once happened in an office were converted to computer or smart phone visits. And health care systems invited patients to use new online portals to message their doctors with a question at any time, American Medical Association president Jack Resneck Jr. told The Associated Press.

“When people figured out this is cool and could improve care, you saw hospitals and practice groups saying to patients, welcome to your portal … you can ping your physician with questions if you want,” Resneck said. “We found ourselves as physicians getting dozens and dozens of these a day and not having time built in to do that work.”

The charges vary for each patient and hospital system, with messages costing as little as $3 for Medicare patients to as much $160 for the uninsured. In some cases, the final bill depends on how much time the doctor spends responding.

READ HERE: https://my.clevelandclinic.org/online-services/mychart/messaging#msdynttrid=bAU8cKe-602S6wFIwSYop1KQswRcT2b2F5mRJ-92OEc

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FTC: Finalizes Ban on Non-Compete Agreements

Posted on May 4, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants LLC

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On April 23rd, 2024, the Federal Trade Commission (FTC) issued a final rule that would ban employers from imposing non-competes on their employees. The FTC asserts that this exploitative practice keeps wages low, and suppresses new ideas. Notably, while the final rule will affect all industries, not just healthcare, this proposal comes at a time when healthcare employers across the U.S. are struggling with staffing shortages.

Existing noncompetes for the majority of workers will no longer be enforceable after the rule goes into effect (i.e., 120 days after publication in the Federal Register); however, the FTC ban appears likely to face a legal challenge, and it could be years before it can take effect.

Under the final rule, noncompetes for senior executives can remain in force under the new ruling, but employers may not enter in or attempt to enforce any new noncompetes, even if that includes a senior executive. The Commission also recognizes that they have no jurisdiction over not-for-profit entities, however they reserve the right to evaluate any entity’s non-profit status. The FTC specifically stated that “some portion of the 58% of hospitals that claim tax-exempt status as nonprofits and the 19% of hospitals that are identified as State or local government hospitals in the data cited by AHA likely fall under the Commission’s jurisdiction and the final rule’s purview.”

While most healthcare employees and workers, including physicians, believe that the ruling is long overdue and that noncompetes “impede patient access to care, limit physicians’ ability to choose their employer, contribute to burnout and stifle competition,” the American Hospital Association (AHA), stated that the “FTC’s final rule banning non-compete agreements for all employees across all sectors of the economy is bad law, bad policy, and a clear sign of an agency run amok.

Look for next month’s (May 2024) Health Capital Topics article that will discuss, in more detail, the final rule, reactions from healthcare industry stakeholders, and potential implications for healthcare valuations (both business and compensation valuations).

MORE: (Read the FTC’s Press Release Here)

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“BREAKING NEWS” Cigna and Humana to Merge?

Posted on November 30, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Cigna and Humana are in talks for a combination that would create a new powerhouse in the health-insurance industry. The companies are discussing a stock-and-cash deal that could be finalized by the end of the year, assuming the talks don’t fall apart.

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A combination of the managed-care providers would be huge, given Cigna’s market value Wednesday morning of about $83 billion and Humana’s of roughly $62 billion.

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Cigna and Humana previously explored merging in 2015, but Humana instead struck a deal with another rival, Aetna, that was blocked by a judge on antitrust grounds, leaving Aetna to be scooped up by CVS in 2018. Another deal that would have combined Cigna with Anthem, now known as Elevance Health, also died after an adverse antitrust ruling.

CITE: https://www.r2library.com/Resource

Editor’s Note: Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans — they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF’s count. Across the country, doctors are grumbling about claim denials and onerous pre-approval requirements by Medicare Advantage plans. Some hospitals and physician practices are so fed up they’re refusing to accept the plans — even big ones like those offered by United Healthcare, Cigna and Humana.

“The insurance companies running the Medicare Advantage plans are pushing physicians and hospitals to the edge,” said Chip Kahn, president and CEO of the Federation of American Hospitals, which represents the for-profit hospital sector.

And, just last week, the industry’s largest lobbying group, the American Hospital Association, fired off a letter to the Centers for Medicare and Medicaid Services warning that some insurers seem intent on circumventing new rules put in place by the Biden administration aimed at reining in some prior authorization and claim denials.

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DAILY UPDATE: HIPPA Web-Tracker Lawsuit and Bank Deposits Delayed as Markets Jump Again!

Posted on November 4, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

“FALL BACK WEEKEND”

By Staff Reporters

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The biggest U.S. hospital lobbying group just sued the Biden administration over new guidance barring hospitals and other medical providers from using trackers to monitor users on their websites. The American Hospital Association (AHA), along with the Texas Hospital Association and two nonprofit Texas health systems, filed a lawsuit against the U.S. Department of Health and Human Services (HHS) in federal court in Fort Worth, Texas. The lawsuit accuses the agency of overstepping its authority when it issued the guidance in December, 2022.

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Bank of America customers have been warned of delays to deposits following an unspecified issue that is affecting “multiple financial institutions”. The company reassured customers on Friday that their accounts remained “secure” and that no action was needed. A statement appearing on customer phone applications read: “Some deposits from 11/3 may be temporarily delayed due to an issue impacting multiple financial institutions.

Wells Fargo and Chase just reported similar situations.

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Here is where the major benchmarks ended:

  • The S&P 500 Index was up 40.56 points (0.9%) at 4,358.34; the Dow Jones Industrial Average (DJI) was up 222.24 points (0.7%) at 34,061.32, up 5.1% for the week; the NASDAQ Composite (COMP) was up 184.09 points (1.4%) at 13,478.28, up 6.6% for the week.
  • The 10-year Treasury note yield was down about 9 basis points at 4.577%.
  • CBOE’s Volatility Index (VIX) was down 0.75 at 14.91.

Banks and other financial companies led Friday’s gainers, on hopes easing Treasury yields will relieve some pressure on lenders’ balance sheets. The KBW Regional Banking Index (KRX) surged 3.3% to end at a seven-week high, while Goldman Sachs Group (GS) shares jumped 4.4% to lead Dow gainers.

Retailer shares were also strong, as were small-caps in general, as the Russell 2000 Index (RUT) posted a gain of 7.6% for the week.

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PODCAST: US Hospital Bond Debt Explained

Posted on April 21, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Do Patients Come First or Creditors?

By Eric Bricker MD

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PODCAST: Hospital “Out-Patient” Department Pricing Explained

Posted on March 8, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

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Hospitals Are Paid More for SAME SERVICE in Outpatient Department Than Doctors Are Paid in Office.

For Example, the SAME Echocardiogram Costs $600 in a Hospital Outpatient Department and $250 in a Doctor’s Office.

By Dr. Eric Bricker MD

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Pity the Poor Hospitals?

Posted on December 20, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

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A Historical Look-Back to the Future?

wayne-firebaugh

By Wayne Firebaugh CPA, CFP® CMP™

www.CertifiedMedicalPlanner.org

Dr. Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that:

… our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action. … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing hospitals in the future. … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel and salaries; many economies have been effected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect. [1]

In Agreement

Many health administration and endowment managers would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. Although they might be startled to learn that Dr. MacEachern made these observations in 1932, there is the old truism that there is nothing new under the sun.

Today

More current healthcare statistics after the November 7th 2012 presidential election and Patient Protection-Affordable Care Act confirmation, suggest that the financial crises are much the same for today’s hospitals as they were for hospitals during the Great Depression.  The American Hospital Association (AHA) recently reported a number of gloomy statistics for hospitals: [2]

  • Hospitals provided $39 billion in uncompensated care to patients in 2010 representing 5.8% of their expenses.
  • Technology costs are soaring as traditional technologies such as X-Ray machines, for $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million, that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic scalpels costing $30,000.

More Metrics

A further review added more daunting numbers: [3]

  • In 2010, 22.4% of hospitals reported a negative total margin.
  • From 1997 through 2009, hospitals saw a small net surplus from government payments from sources such as Medicare and Medicaid deteriorate into a deficit approaching $35 billion.
  • Emergency departments in 47% of all hospitals report operating at, or over, capacity partially reflecting an approximate 10% decline in the number of emergency departments since 1991.
  • The average age of hospital plants has increased 22.5% from 8.0 years to 9.8 years in just fifteen years.
  • From 2003 through September 2007, hospital bond downgrades have outpaced hospital bond upgrades by 19%.

In a time when so much seems different yet so much seems the same, hospitals are increasingly viewing their endowments as a source of help. But what is an endowment?

Latin Roots

The same Latin words that give rise to the word “dowry” also give rise to the word endowment.[4] Interestingly, the concepts of a dowry and an endowment are in many ways similar. Both are typically viewed as gifts for continuing support or maintenance.

With respect to the healthcare entity, an endowment is generally used to smooth variations in operating results and to fund extra programs or plant purchases. Any entity that enjoys the support of an endowment also encounters the conflicting objectives between current income and future growth.

Hospital

Assessment

Dean William Inge, a 19th century cleric and author, aptly noted that: “Worry is interest paid on trouble before it is due.”

When managing an endowment, it is important that the institution focus its attention on those items that it can control rather than worrying about those it cannot control. Successful endowment managers seem to agree that there are at least two major areas subject to the endowment’s control: asset allocation (also known as investment policy) and payout policy.

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[1]   MacEachern, M.T., MD. “Some Economic Problems Affecting Hospitals Today and Suggestions for Their Solution.” The Bulletin of the American Hospital Association. July 1932.

[2]   Steinberg, C. Overview of the U.S. Healthcare System.  American Hospital Association (2003). Carline Steinburg is Vice President, Health Trends Analysis, for AHA.

[3]   “Trends Affecting Hospitals and Health Systems.”  TrendWatch Chartbook 2010.  American Hospital Association (2010).

[4]   Merriam-Webster Online.

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Physicians Seeking Financial Support from Hospitals

Posted on December 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Results of a New Survey

[By Staff Reporters]

Since domestic economic conditions began to deteriorate in September 2008, the number of doctors seeking financial support from hospitals has increased, according to a new report from the American Hospital Association. 

Study Results

  • Overall: 70%
  • Physicians Seeking Increased Pay for On-Call or other Services Provided to Hospital: 79%
  • Physicians Seeking Hospital Employment: 74%
  • Physicians Seeking to Sell Their Practice: 36%
  • Physicians Seeking to Partner on Equipment Purchases: 26%
  • Other: 13%

Source: American Hospital Association. The Economic Crisis: Ongoing Monitoring of Impact on Hospitals: Results from an AHA Rapid Response Survey, August/September 2009. www.aha.org

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This Time the Hospital Financial Crisis is Different

Posted on March 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Oh Really … No so Fast!

Submitted by J. Wayne Firebaugh, Jr; CPA, CFP®, CMP™ho-journal2

Dr. Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that:

… Our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action. … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing hospitals in the future … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel and salaries; many economies have been affected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect…

Source:  Steinberg, C. Overview of the US Healthcare System; American Hospital Association 2003.

Many hospital CXOs, healthcare administrators and physician executives would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. However, they might be startled to learn that Dr. MacEachern made these observations in 1932! There is the old truism that there is nothing new under the sun.

American Hospital Association Statistics

Healthcare statistics suggested that the financial crisis is much the same today as it was for hospitals during the Great Depression. The American Hospital Association’s (AHA) reported gloomy statistics for hospitals include:

  • In 2001, 29% of hospitals had negative total margins.
  • Approximately $101.3 billion of uncompensated care was provided between 1997 and 2001 with an average annual increase of 16% during that time period.
  • Emergency departments in 62% of all hospitals report operating at, or over, capacity.
  • Technology costs are soaring as traditional technologies such as X-Ray machines, for $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic scalpels costing $30,000.
  • Between 2000 and 2002, 33% of hospitals reported increases in liability premiums of more than 100%.
  • The average age of hospital plants has increased 21% from 7.9 years to 9.6 years in just one decade.
  • In the four years ending 2002, hospital bond downgrades have outpaced hospital bond upgrades by almost 5 to 1.

Editor’s Assessment

As editor’s of the premium subscription, two volume, 1,200 pages, institutional print-guide Healthcare Organizations [Financial Management Strategies], we prefer engaged readers and contributors like Mr. Firebaugh, who demand and create compelling content like the above. Please review these links for same.

www.HealthcareFinancials.com

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Domestic Economy Sickens Hospitals

Posted on December 5, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

AHA Reports Negative Financial-Operating News

Staff Reporters

Many hospitals are seeing the effects of the economic downturn. More than 30% of respondents to a recent American Hospital Association [AHA] survey reported a significant decline in patients seeking elective care and 40% reporting a drop in admissions overall. The majority of hospitals also noted an increase in patients unable to pay for care.

DATABANK Results

The report is based on survey results from 736 hospitals and information from DATABANK, a Web-based reporting system used in 30 states to track key hospital trends:  

  • Falling profit margins to [-] 1.6% – from [+] 6.1% year-over-year
  • Medicare and Medicaid patient care is growing
  • Reducing administrative costs (60%), staff (53%) and services (27%)
  • Borrowing for facility and technology improvements has decreased

Capital investments are also being postponed or delayed:

  • 56% delayed plans to increase capacity;
  • 45% delayed purchase of clinical technology or equipment; and
  • 39% delayed investments in new information technology.

Assessment

The report was based on data from two major sources. A survey, “The Economic Crisis: Impact on Hospitals,” provides data from 736 hospitals from late October 2008 through Nov. 10, 2008.  DATABANK figures represent early results from 557 hospitals reporting data for July through September 2007 and 2008 as of Nov. 11, 2008.

Conclusion

And so, your thoughts and comments on this Executive-Post are appreciated. How [much] has the economy affected your healthcare organization?

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