When Congress enacted the No Surprises Act (NSA), the primary objective was straightforward: protect patients from unexpected out-of-network medical bills. Since implementation in 2022, however, the law has created a complex framework for resolving payment disputes between providers and payors through the Federal Independent Dispute Resolution (IDR) process.
What began as a well-intentioned arbitration mechanism has evolved into a system burdened by millions of disputes, operational
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Health IT & Digital Health-Opinion | Op-Eds | Guest Columns | Analysis, Insights - HIT Consultant
The Alert Fatigue and EHR Friction Killing Digital Health Apps
Right at this moment, a physician is logging out of a new digital health tool for the very last time. Not because it stopped working. But it started feeling like a chore rather than a savior. The tool never worked right to keep up with the fast pace of her daily workflow.
She will eventually return to her old school ways. A sticky note, a quick phone call, and an old spreadsheet that keeps the staff on life support. That six-figure platform her health system just built? It
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Leveraging Real-World Data for Proactive Protocol Design
Clinical trials have grown more complex than ever before. Protocols are becoming more specialized, endpoints more refined, and eligibility criteria narrower and more precise. At the same time, development programs are expected to move faster and operate with greater efficiency. Despite this dual pressure, feasibility projections often rely on high-level estimates or investigator recall rather than validated assessments of patients who truly meet protocol criteria in a real-world clinical
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Alternative Funding Programs vs. In-Benefit Optimization: Designing a Sustainable Specialty Drug Strategy
Specialty medications are expanding what is clinically possible, but not without a price. The affordability gap on these therapies continues to widen, placing sustained pressure on health plan budgets. U.S. prescription drug spending reached approximately $467 billion in 2024, with projections exceeding $556 billion by the end of 2026. As costs rise, employers and pharmacy benefit managers (PBMs) face increasing pressure to ensure that high-cost therapies remain both clinically appropriate and
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Don’t Let Legacy Data Derail Your Health System’s Growth
As health systems continue expanding through acquisitions and partnerships, many find themselves racing to bring new practices onto shared EHR platforms. The motivation is clear: unify care, streamline operations, and unlock value across the enterprise. But beneath that strategic vision lies a messy operational reality – one that too often gets overlooked until it’s too late.
At the center of this challenge is legacy data.
For every practice or partner brought into the fold, there's a
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4 Critical Guardrails for Community Hospital Tech Procurement
Healthcare is moving toward models that reward outcomes, continuity, and population health management, yet disparities in access to specialized care continue to persist. And while community hospitals are central to closing this gap, they are being inundated with technologies that promise to transform care yet are structurally difficult to translate from large academic medical centers to smaller ones.
Rural hospitals operate with lower patient volumes and thinner margins, practical
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Rural Hospitals Are Collapsing Under Administrative Burden That AI Alone Cannot Solve
More than 180 rural hospitals in the United States have closed since 2005, according to the Chartis Center for Rural Health, while providers spend over $25 billion annually on claims adjudication, with nearly $18 billion of that tied to claims that are ultimately paid, according to Premier Inc.
That’s not a demand problem. It’s an administrative one. And increasingly, it’s a technology infrastructure problem tied to how work is managed, measured, and automated.
And for rural hospitals
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Shifting the Interoperability Axis: Why Layered Extensions Fail Modern Hospital Core EHRs
Every year, there are roughly 33.5 million hospital admissions, 155 million emergency department visits, and hundreds of millions of outpatient encounters across the United States. At the same time, healthcare spending has reached $4.9 trillion annually. When patient data, especially for such a large number of healthcare consumers, is fragmented across multiple applications, vendors, and systems, the effect is exponential. It is multiplied across every encounter, every workflow, and every
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How the REAL Health Providers Act Will Eradicate “Ghost Networks”
The proposed Requiring Enhanced and Accurate Lists (REAL) Health Providers Act—also referred to as the RHP Act—recently signed and expected to take effect for plan year 2028, represents a significant shift in how healthcare providers are regulated, credentialed, and represented to Medicare Advantage members.
The proposed requirements aim to provide health plan members with greater transparency, accessibility, and accuracy within provider directories in their member portals. Payers will need
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If the Data Center Goes Down, Patient Care Goes with It
Healthcare organizations have spent years modernizing clinical technology. All of it depends on one thing: the data center staying online. Here’s what resilient healthcare infrastructure actually looks like.
Healthcare IT leaders have spent years modernizing their infrastructure: migrating to electronic health records, deploying telehealth platforms, integrating remote monitoring devices, connecting imaging systems to clinical workflows, and more. The investment has been substantial, and the
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