Each month, the Ascendient Research Team curates and analyzes the most pressing, most actionable healthcare research.

Meet the Team is our blog series introducing some of the amazing professionals at Ascendient – who they are and what makes them tick. This month, meet Greg Flicek, a senior manager who joined the team in May 2021. Public accounting, national consulting groups, higher education, in-house hospital management – you’ve practiced in a variety… Read More

Back in 2021, my wife and I were searching for our next home. The market seemed insane. Home prices were seemingly increasing every day and every offer we made encountered double-digit competition.  Our prospects seemed dim, and it felt like the risk of overpaying increased with every passing day. Contrary to rising prices, interest rates… Read More

Big changes are likely on the way for nonprofit health systems accustomed to “checking the boxes” in their community benefit reporting. Last month, two Democrat and two Republican senators wrote to the IRS questioning $28 billion in tax exemptions for nonprofit providers that “avoid providing essential care in the community for those who need it… Read More

As a healthcare finance consultant, people always ask me, “Are hospitals losing money?” or if they’re more pessimistically inclined, “Why are hospitals still losing money?” That may not make for great cocktail party conversation, but the questions are important, and the answers are … complicated. In an October blog post, we warned that 88% of… Read More

CMS wants to take better care of older Americans with multiple chronic conditions, but providers aren’t taking the billion-dollar bait. Nearly a decade after billing codes for Chronic Care Management (CCM) were first introduced, fewer than 10% of primary care providers are offering the most basic level of service. That’s bad for patients and for… Read More

Meet the Team is our blog series introducing some of the amazing professionals at Ascendient – who they are and what makes them tick. This month, meet Katie Reilley, a senior managing consultant who joined the team in May 2021. You studied neuroscience as an undergrad before going back to Johns Hopkins for a Master… Read More

If you work in public health, you’ve surely experienced the burnout trend firsthand. Experts say state and local health departments have lost 15% of essential staff over the past decade, and 80,000 full-time workers are needed immediately just to provide “a minimum package of public health services.” From analysts to epidemiologists, public health professionals have… Read More

Based on survey data, the future of public health is looking pretty grim. According to a March 2023 study in Health Affairs, local health departments could lose more than half their workforce by 2025. What’s worse, after a 17% decline prior to the Covid pandemic, health departments already fall 80,000 workers short of the staffing levels needed to… Read More

Similar to other use cases, AI tools represent a supplemental resource when performing CON tasks, but are (for now) no substitute for personal experience and human intelligence Stories about generative AI technology have proliferated in newsfeeds and publications since the November 2022 release of ChatGPT, the latest chatbot from San Francisco-based technology company OpenAI. Users… Read More

It’s bad for consumers when they have only one choice in service providers, right? That’s certainly the conventional wisdom in healthcare. When two hospitals announce some type of combination, economists and regulators (and sometimes trial lawyers) automatically start warning about market power, higher prices, and lower quality. Competition in healthcare is the highest value, it… Read More

You can scarcely read the news these days without seeing an item about ChatGPT. The loquacious artificial intelligence application might be the buzziest healthcare story we’ve seen in 20 years or more. AI used to seem like a five- or ten-year trend for most hospitals. Suddenly, it’s about five minutes away. If you’ve been wondering… Read More

If we want to transform healthcare, nearly everyone agrees that more primary care – especially preventive care – is the key. When patients see their PCP more often, minor health issues get caught earlier, allowing for cost-effective treatments that slow or prevent escalation to major health issues. Medicare understands that. As the primary insurer for… Read More

For a purpose-driven firm full of purpose-driven individuals, the holidays are extra special – a chance to reflect on our work and give back in ways that go beyond our everyday mission. Recently, our team from across four states gathered in Chapel Hill, NC, for a day of service and celebration. Working with two wonderful… Read More

Driven by new payment models and better health outcomes, hospitals for years have been buying medical practices as a key part of their physician alignment strategy. With more corporate buyers now emerging – often from outside the healthcare industry – is it time for a re-think? When the Physicians Advocacy Institute (PAI) released its recent… Read More

If you have questions about the new Rural Emergency Hospital model, we finally have some answers. Two years since Congress passed the law authorizing Emergency Rural Hospitals – and two months before billing can begin – we now know exactly what the new provider type will entail. With yesterday’s release of the Final Rule for… Read More

How bad is the financial crisis facing US hospitals? According to Ascendient’s exclusive analysis, 88% of health systems have experienced a year-to-date net loss in 2022 – compared to just 2% last year. Healthcare financial planning is never easy, but our new analysis of health system finances shows why it might be tougher than ever… Read More

Warning: The next paragraph is going to sound like a brag, but it’s not. It’s actually leading up to a big worry that I have for hospitals and health systems, so please keep reading. At Ascendient, we’ve been doing healthcare consulting for nearly 30 years, and I can honestly say that I’ve never seen higher… Read More

You’ve heard the old adage to “fail fast, fail often, fail forward”? That seems to be the business philosophy at Amazon, which recently announced it would shutter the upstart Amazon Health division that had caused widespread consternation in traditional healthcare circles. (As healthcare strategy consultants, we shared some of that consternation, as you can see… Read More

Medicare’s Inpatient Quality Reporting (IQR) program is getting a major dose of health equity next year, as we’ve explained in our Higher Thinking series. (Click here to read the in-depth report.) But next year’s changes are just the beginning, and 2024 will see mandated reporting that goes much further. As CMS notes, the new reporting… Read More

Last week, CMS released its final rule for the Hospital Inpatient Prospective Payment System (IPPS), and a larger-than-expected boost in operating payments got much of the attention from healthcare journalists and membership associations like the AHA. But beyond the immediate (and somewhat deceiving*) headline that reimbursement will increase by $2.6 billion, we at Ascendient were… Read More

We’ve long argued that healthcare transformation is fundamentally changing the calculus on inpatient hospital rooms – flipping them from a financial asset to a financial liability. That’s especially true in rural areas, where a sparse population plus added staffing challenges makes it hard to cover the fixed costs of inpatient care. When Medicare officially begins… Read More

From a strictly financial standpoint, the Covid pandemic steadied the outlook for Critical Access Hospitals (CAH) across the United States, but all five factors responsible for that trend have now reversed sharply, suggesting a looming crisis. Perhaps the easiest way for hospitals to remain financially secure through periods of uncertainty is with a strong days… Read More

The top line: Accessible primary care is critical to population health – but problematic for healthcare facility planning. In one NC county, a healthcare system is partnering with a local church to improve accessibility with minimal investment in bricks and mortar. Nestled in the foothills of the Blue Ridge Mountains, Cleveland County is one of the… Read More

In March, President Joe Biden announced a new test-to-treat initiative that allows some pharmacies to prescribe life-saving Covid antivirals for patients who walk in and test positive – a policy that begins to recognize the role of pharmacy in healthcare transformation. No more shuttling between a doctor’s office and pharmacy? That seems like a commonsense… Read More

As North Carolina considers various proposals for Certificate of Need reform, the state’s General Assembly invited Ascendient founder Dawn Carter share her CON expertise with the Joint Legislative Committee on Access to Healthcare and Medicaid Expansion. In a 30-minute presentation followed by 10 minutes of questions, Dawn used extensive data to refute the notion that… Read More

If you’re a healthcare provider that relies on digital marketing, your life is about to get a lot more difficult. This year, Google is phasing out third-party cookies on its Chrome web browser, which is the primary on-ramp for half of all Americans accessing the Internet. Other popular web browsers, like Safari and Firefox, have… Read More

As Covid-19 slowly transitions from pandemic to endemic status, state and county governments all across the country are reckoning with the lessons of a two-year public health emergency. One area getting a lot more focus: public health strategic planning. The Build Back Better Act requested more than $16 billion for healthcare infrastructure, including $7 billion… Read More

Value-based care is a linchpin of healthcare transformation because there is simply no way to bend the cost curve without curtailing fee-for-service payment arrangements. While some traditional providers continue to struggle with the transition to value-based payments, national organizations like VillageMD clearly believe they have “cracked the code” for offering profitable primary care. VillageMD cares… Read More

Back in the old days (say, 2019) county health departments rarely made news unless a popular restaurant got shut down after failing inspection. But two years of pandemic restrictions have changed all that. Headlines are now frequent and foreboding, like this one from KHN: “Missouri’s War on Public Health Shows Extent of National Rift.” The… Read More

What’s in a name? There’s a battle brewing over the familiar P.A. designation found in many primary care teams, and it’s just one more sign of the status quo resisting true healthcare transformation. As reported recently by Kaiser Health News, physician assistants would like to re-brand as “physician associates,” but doctors are fighting back, arguing… Read More

Ascendient is pleased to announce that Joann Anderson has joined the firm to launch a new practice area focused on strengthening healthcare operations in rural settings. With a national reputation honed over 40+ years, Joann brings unmatched experience in rural healthcare leadership, including long service as both CEO (UNC Health Southeastern) and board member (Appalachian… Read More

COVID-19 continues to have a dramatic impact on the financial performance of healthcare systems across the United States. Ascendient analyzed multiple data sources from the first year of the pandemic and found five key financial takeaways for hospital planning. In 2020, healthcare systems experienced: Decelerated net patient revenue growth Increased salaries and benefits Weakened profitability… Read More

End-of-life care doesn’t get much attention in Washington, despite the endless political posturing over rising healthcare costs. It’s hard to understand that indifference, given that 25 percent of Medicare spending goes toward care for people during their last year of life. If ever there were a chance to bend the curve, hospice and palliative care… Read More

With Medicare Part A facing insolvency as early as 2026, CMS is looking to make dramatic moves. The CMS Innovation Center is aiming to have 100 percent of Medicare beneficiaries in some sort of accountable care relationship by 2030 – a shift that would have major revenue implications for hospitals and health systems. A closer… Read More

Our founder, Dawn Carter, wrote the following opinion piece with Joann Anderson, the outgoing CEO of UNC Health Southeastern in Lumberton, NC. A shortened version was published by the Raleigh News & Observer on Nov. 14, 2021. Rural healthcare is facing a crisis all across America, and North Carolina is no exception. From Belhaven to… Read More

If you’ve been working remotely for the past year, would a $30,000 raise entice you back into the office? In a recent survey of 3,000 workers at dozens of large US companies, the vast majority of respondents said they would forego the hefty raise if they could keep working in their pajamas. I’ve spent more… Read More

Robust employment contracts, income guarantees, signing bonuses, loan forgiveness: Faced with a growing shortage of providers, many hospitals and health systems are desperate to one-up each other with high-dollar physician recruitment incentives. Usually, these incentives are aimed at the physician as a physician. But what about incentives that recognize the physician is also a person?… Read More

Meet the Team is our new blog series introducing some of the amazing professionals at Ascendient – who they are and what makes them tick. This month, meet Angel Lopez-Collazo, a healthcare consultant who joined the team in January 2020. In your LinkedIn bio, you call yourself a healthcare consultant, of course, but also a… Read More

As I write this, the debate over America’s debt ceiling has reached a fever pitch, with dire predictions of mass layoffs, delayed Social Security checks, skyrocketing mortgage rates, and more. All that sound and fury is not a bad thing, since the consequences of a default would be catastrophic – a “meteor” on a collision… Read More

It seems like everyone is grading hospitals these days. Safety, value, clinical outcomes, patient satisfaction – the list of metrics for judging a “good” hospital just keeps growing and growing, so maybe it’s no wonder that the American Hospital Association is pushing back on the newest report card from the Lown Institute. Now in its… Read More

Ascendient has always been a purpose-driven firm. Our relentless focus on healthcare transformation goes much deeper than some academic concern over best practices. We truly believe that every person deserves to get the right care in the right place at the right time, and that’s only possible in a transformed healthcare system where incentives and… Read More

On August 30, 2021, North Carolina Gov. Roy Cooper signed Senate Bill 462 into law. The bill, which amends the Certificate of Need (CON) law as summarized below, takes effect on October 1, 2021. Increase in Three CON Cost Thresholds The bill increases three cost thresholds above which CON review would be required. Notably, these… Read More

My Roomba just arrived, and I am beyond thrilled! Fed up with my inability to keep up with my golden retriever’s shedding, on a whim I did about 10 minutes of research on robotic vacuums and then added one to my Amazon cart. Less than 24 hours later, this game-changer arrived at my door. A… Read More

If you’re looking for the lowest price on a rectal resection or a radical hysterectomy, you might be glad to know that the Biden Administration plans to fine hospitals up to $2 million a year if they fail to publish those prices online. Yes, this is the latest proposal for keeping a lid on healthcare… Read More

Amazon is on a hiring spree, and it could affect your ability to attract and retain medical professionals. This month, Amazon executive Babak Parviz said his company would need to hire “thousands” of additional employees for the national rollout of its telemedicine service, Amazon Care. For traditional healthcare providers, that might signal a squeeze on… Read More

“Since 2010, 120 rural hospitals have closed across the United States.” We hear statistics like that a lot – so often, in fact, that the big numbers start to lose their impact. But in a story last week from my local news station, WRAL, the reporter went on to list by name seven of the… Read More

It’s rare that an emerging delivery model can show immediate progress on three of the measures that matter most in healthcare transformation: better outcomes at lower cost with higher patient satisfaction. If this is the “healthcare trifecta,” Hospital at Home may be one of the most promising trends in many years – yet it rarely… Read More

Founder says largest ever one-time expansion will add capacity as healthcare leaders push forward with transformation in the wake of Covid-19. Chapel Hill, NC – Ascendient Healthcare Advisors, a top-50 consulting firm for healthcare strategy, planning, and feasibility, today announced the addition of three managing consultants with nearly four decades of combined experience. “In more… Read More

Mobile Integrated Healthcare is a broad and somewhat confusing term as it often operates differently from place to place in order to meet a community’s unique needs.  In 2016, the National Association of Emergency Medical Technicians (“NAEMT”) and other partnering organizations updated their vision statement that defines and clarifies MIH: “Mobile Integrated Healthcare – Community… Read More

Recently, we were asked to participate in a virtual panel—hosted by our friends at Jarrard Phillips Cate & Hancock—regarding the impact of COVID-19 and the election on healthcare mergers and acquisitions. Check out the panel’s expert opinions here. In our decades of hospital consulting experience, we know that no two healthcare M&A transactions are alike…. Read More

Maryland is the only state in the country that has a waiver from the Medicare Prospective Payment System (“PPS”) and related regulations. The waiver allows the State to manage its healthcare costs through the evolution and implementation of progressive healthcare payment models.  In January 2019, the Total Cost of Care model (“TCOC”) replaced the All-Payer… Read More

Maryland is the only state in the country that has a waiver from the Medicare Prospective Payment System (PPS) and related regulations. The waiver allows the State to manage its healthcare costs through the evolution and implementation of the State’s unique payment model.  In the second of the three-part series, we examine how Maryland’s unique… Read More

This is the first in a three-part series that explores the unique all-payer model for hospital payments in Maryland.  This “Medicare waiver” from the typical Medicare rules and regulations has made the entire State of Maryland a demonstration project in healthcare transformation.  What is it, how is it working and what can we learn from… Read More

Healthcare leaders sometimes say they don’t see the value in health system planning because no one can predict exactly what the future healthcare delivery environment will look like.  They reason that, without a crystal ball, there is little point in planning any differently than they have in the past.  We believe this viewpoint is misguided… Read More

A healthcare revolution is on the horizon. We know that change in healthcare is driven by change in payment. Though payment today still is largely based on volume—especially volume of high-tech procedures, we’re seeing a shift to payment that incentivizes the least costly, most effective care. As a result of payment shifts, healthcare delivery is… Read More

For those who have been following our work and research during much of the past decade, you have heard us continue to express our concern for the transition to site-neutral payment and the associated impact on many of our community hospital clients.  In our Devastation of Site-Neutral Payment video blog, we quantified that impact on… Read More

Long considered a key component of a future healthcare delivery system, virtual care adoption has accelerated across the country as healthcare systems find new, safer ways to continue providing services to their patients during the COVID-19 outbreak. Before the pandemic, the move to virtual care saw great success in some markets yet floundered in others…. Read More

Long considered a key component of a future healthcare delivery system, virtual care adoption has accelerated across the country as healthcare systems find new, safer ways to continue providing services to their patients during the COVID-19 outbreak. Before the pandemic, the move to virtual care saw great success in some markets yet floundered in others…. Read More

All too often these days, another rural hospital announces its closure. Even more disheartening than losing the blue “H” sign is that many of these communities lose access to healthcare. According to data from the Sheps Center, more than 100 rural hospitals have closed since 2010, and 60% of these communities have no rural healthcare… Read More

With the world having fundamentally changed over the last 90 days, many healthcare organizations may need an overhaul of their current strategy—but who has time for strategic planning in the midst of a pandemic?  All too often traditional strategic planning involves belabored processes over an extended period of time that ultimately leads to little, if… Read More

As we begin to emerge from the country’s initial response to COVID-19, from every sector comes the question, “What is the new normal”? For healthcare organizations who are at the frontline of this pandemic, it is a pivotal moment to re-examine strategies that will need to adapt for “The New Normal.” Despite the pause in… Read More

Ascendient is pleased to offer to any hospital or health system in the US a free, customized COVID-19 Bed Capacity Assessment. News outlets are sounding the alarm regarding the lack of available hospital beds to accommodate the COVID-19 pandemic as it rolls across the US. Releases by both Health Affairs and the Harvard Global Health… Read More

We recognize that what you all are dealing with on the front lines of COVID-19 is much more significant than what we can offer to do. At the same time, we feel a strong obligation to assist you in any way possible. FREE COVID-19 Bed Capacity Assessment Though some states have already relaxed regulations regarding… Read More

“The More Things Change, the More They Stay the Same.[1]” When Ascendient was launched in the summer of 1994, Congress was debating the Clintons’ “Managed Competition” plan to reform the US healthcare system.  It faced defeat a few months later.  In the decades since, we applauded the passage of the Affordable Care Act in 2010,… Read More

TRANSCRIPTION: This is Brian Ackerman. Today I want to talk to you a little bit about rethinking primary care recruitment. If you’re in the recruiting business, you know how difficult it is to attract and retain primary care physicians in particular. What I want to do today is really outline why you might want to… Read More

TRANSCRIPTION: This is Brian Ackerman. I want to talk to you today about the devastation of site-neutral payment. Site-neutral payment is nothing new. We’ve worked with hospital clients for a number of years to discuss how from a competitive standpoint, they may look to push certain services into a freestanding setting and the associated implications… Read More

TRANSCRIPTION: I’m Daniel Carter. I wanted to take a few minutes today to share some ideas with those of you who may be working on your community health needs assessments. Now, these are ideas that I have developed over a number of years working with all types of organizations including public health departments, FQHCs, and… Read More

Announcements by CMS and recent changes in the healthcare industry demonstrate that Ascendient’s forward-looking approach, aided by the HealthytownTM model we developed, has accurately predicted the road signs now visible on the path to healthcare transformation. We have known for some time that the U.S. healthcare system as it exists is not sustainable. Costs continue… Read More

A recent federal report indicates Medicare Part A is on shakier ground than was previously anticipated. Growing enrollment and use coupled with rising healthcare costs and lower payroll taxes will likely increase financial pressures in coming years. Congress has already enacted payment reductions to providers, and one can only expect there will be more to… Read More

  Dear Clients and Friends, Please enjoy this short video of our thoughts for the season.  Thank you for your continued friendship, support, and partnership.       Ascendient will be closed December 24, 2018 through January 1, 2019.  Dawn Carter will be the partner on-call during that time for any urgent issues. Our home office… Read More

A growing shortage of physicians coupled with rising costs and stronger patient demand are pressuring the U.S. healthcare industry in ways we’ve never seen before. Transforming care delivery starts with specialists, hospitals and emergency rooms being reserved for those patients that need it the most while moving more services to primary physicians. Yet for primary… Read More

Dawn Carter, Ascendient After decades of unabated growth in healthcare costs, payors, consumers and the government alike are finally taking action to eliminate cost-shifting and to force providers to assume more risk. From MACRA and the lower reimbursement rates of Medicare Advantage to the growing use of freestanding sites, hospitals are facing a transformational shift… Read More

The future is hard to predict however if you plan using scenario planning you can account for numerous scenarios.  In this short video, Daniel Carter will discuss externalities in strategic planning.  Watch as Daniel unpacks this topic. Video Transcription: I’m Daniel Carter and I want to talk today about dealing with some of the externalities… Read More

  In this short video, Daniel Carter will discuss the evolution of microhospitals as he highlights two examples. Video Transcription: I’m Daniel Carter. I want to talk a little bit today about the evolution of microhospitals as it pertains to regulations.  To do that I want to talk about a couple of specific states. First… Read More

Changing market forces across the healthcare industry will have major reverberations across key provider, consumer, and other stakeholder communities that operate both within and outside of traditional healthcare system networks. And as a new and dramatically different type of healthcare delivery model emerges, healthcare executives can no longer afford to embrace a “business as usual”… Read More

In this short video, Dawn Carter will discuss three business giants coming together and how that will directly impact the future of healthcare. Video Transcription: I’m Dawn Carter. There was an exciting announcement recently about three business giants coming together to focus on the healthcare delivery and cost reduction for their employee populations. There has… Read More

  In this short video, Daniel Cater will discuss how microhospital can fit into your strategy using our Healthytown™ model. Video Transcription: I’m Daniel Carter, and I want to talk a bit today about how Microhospitals fit in a Healthytown strategy.  For those of you who have followed our Healthytown strategy discussion over the years,… Read More

In this short video, Dawn Carter will discuss four principles behind transformed care delivery. Video Transcription: I’m Dawn Carter. I want to spend a few minutes talking about principles of transformed care delivery. If we have a transformed payment system that incentivizes the most effective care in the least costly setting, how will that transform… Read More

In this short video, Brian Ackerman will discuss the fundamentals of recruitment planning. Video Transcription: Hello. My name’s Brian Ackerman, and I want to talk to you a little bit about your recruitment strategy and the key puzzle pieces that go into that planning process. If you’ve heard me talk before, either in this setting,… Read More

In this short video, Daniel Carter will discuss the characteristics of a microhospital. Video Transcription: I’m Daniel Carter and I wanted to talk a bit today about microhospitals. In healthcare strategy, we often hear terms that cause a lot of excitement, and sometimes, that excitement is for good reason and sometimes, it ends up being… Read More

In this video, Dawn Carter discusses the principles of transformed payment and presents four inherent principles in that system. Video Transcription: I’m Dawn Carter. I want to spend a few minutes today talking about the principles of transformed payment. The healthcare industry in the United States has a long history of care delivery being heavily… Read More

In this short video, Brian Ackerman will discuss the key considerations for a community needs assessment. Video Transcription: My name’s Brian Ackerman. I want to talk to you a little bit about physician needs assessments and some of the key considerations you might want to factor in to your needs assessment process. Given all the… Read More

  In this short video, Dawn Carter will briefly discuss the future of medicare and what the future holds without a transformed payment system. Video Transcription:  I’m Dawn Carter. I want to talk today about the Medicare wall that we are running toward. We’ve talked in other blogs about how we believe that the financing… Read More

Is competition always healthy in the health care world? Dawn Carter and Richard Bruch go “On the Record” about possible changes to the “certificate of need” laws in North Carolina.