'Reimbursement wars' keeping hospital execs up at night, Mercer Health CFO says

Hospitals' "reimbursement wars" with payers is one of the most pressing issues facing healthcare executives this year, Mercer Health CFO Jon Dingledine said Feb. 22 during a board of governors meeting, according to The Daily Standard.

"Our staff are going to battle every day with insurance companies who are literally changing the rules on a weekly basis in terms of what they're going to pay for," Mr. Dingledine said. "Things that were covered six months ago are now being denied, despite no evidence of abuse, despite the same trauma protocol that remained for years. For whatever reason, it's now being denied."

Mr. Dingledine highlighted prior authorization as a particular challenge for Coldwater, Ohio-based Mercer. 

"How many hours are spent by our staff trying to get things approved that again, the treatment protocols haven't changed, there's no evidence that hospitals have abused this certain code or treatment?" he asked. "But yet the first answer for a lot of these insurance companies is to deny it. Because again, it ultimately saves them money."

Staffing shortages, inflation and rising cost of supplies, equipment and medicine also continue to eat into hospital and health systems' bottom lines, according to Mr. Dingledine.

From 2021 to 2022, the healthcare sector recorded an $86 billion increase in staffing expenses, while non-staff expenses such as supplies, medication and services increased by $49 billion, according to The Daily Standard.

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