Navigating the One Big Beautiful Bill Act and Site Neutral Payment Shifts with Laura Dyrda

Summary

Becker’s Healthcare Podcast Summary: Navigating the One Big Beautiful Bill Act and Site Neutral Payment Shifts with Laura Dearda

Release Date: July 10, 2025

Introduction

In the July 10, 2025 episode of Becker’s Healthcare Podcast, host Chanel Bunger engages in a comprehensive discussion with Laura Dearda, Vice President and Editor-in-Chief at Becker’s Healthcare. Laura provides an in-depth analysis of two pivotal topics currently shaping the U.S. healthcare landscape: the One Big Beautiful Bill Act (HR1) and the emerging trends surrounding site neutral payment policies.

Impacts of the One Big Beautiful Bill Act (HR1)

Laura Dearda begins the conversation by examining the recent enactment of the One Big Beautiful Bill Act, signed into law by President Donald Trump on July 4th. She highlights the immediate reactions from hospital and health system executives who have been diligently analyzing the legislation to understand its ramifications.

“Many of the changes occur over time or will be phased in over two to three years and even out over the next decade in terms of impacts,” Laura explains (00:17). This phased approach means that healthcare organizations must strategically plan for long-term adjustments concerning Medicaid, ACA enrollment, and provider collaborations.

Financial Implications and Challenges for Hospitals

A significant concern raised by Laura is the potential financial strain on hospitals, especially smaller rural institutions that operate on thin margins. She notes:

“The biggest things that we're hearing from hospitals and health systems... they're really talking a lot about Medicaid and what that could do to more broadly impact their overall financial situation and community in general” (00:40). Reduced payments from government payers like Medicare and Medicaid pose a severe threat, potentially leading to hospital closures if adequate support isn’t provided.

Laura discusses the Rural Health Transformation Program, which allocates $150 billion over five years to mitigate losses. However, she emphasizes that many believe this funding is insufficient without substantial state-level intervention.

Strategic Responses by Healthcare Organizations

In response to these financial pressures, healthcare organizations are exploring various strategies:

• Partnerships and Consolidation: Forming alliances with physician and specialty groups to enhance service offerings and patient care.
• Innovation and Modernization: Investing in new technologies and modernizing facilities to improve efficiency and patient outcomes.
• Expansion of Charitable Care: Preparing for increased charitable care needs as Medicaid redeterminations tighten, potentially leading to more uncompensated care burdens on hospitals’ emergency departments.

“There’s still a lot of innovation. There’s still a lot of energy around making sure that... there’ll be creativity in space to figure out new ways of delivering care,” Laura remarks (05:10). This resilience underscores the healthcare system's capacity to adapt amidst policy-driven challenges.

Site Neutral Payment Policies

Shifting focus, Laura delves into the topic of site neutral payment policies, particularly their impact on hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). She references insights from Dr. Adam Brueggeman, CEO of Texas Spine Center, who advocates for physician groups and surgery centers.

Currently, HOPDs receive higher reimbursement rates than ASCs due to their broader range of services. However, the administration is contemplating reducing these disparities:

“Site neutrality would actually lower the rates for hospital outpatient departments to something similar for the ASC,” Laura explains (07:45). This policy aims to level the financial playing field between hospitals and independent surgery centers.

Potential Consequences for Healthcare Providers

The shift towards site neutrality could have profound effects:

• Employment Models: Hospitals may find it challenging to continue employing physicians at competitive rates, potentially leading to a migration of specialists to independent practices or ASCs.

  “If they’re not able to extend or increase pay, will that mean employed physicians decide to go private or independent...” (09:00)

• Impact on Group Purchasing Organizations (GPOs): Reduced reimbursement rates may lead to tougher negotiations with suppliers and vendors, affecting hospitals' operational costs.

  “How are they thinking about the impact of that on their suppliers, their vendors and what the vendors might need in order to cover a gap in contracting there?” (09:45)

• Wages and Staffing: Hospitals might face constraints in increasing wages, affecting their ability to retain nursing staff and other essential personnel.

Strategic Adaptations and Future Outlook

Laura anticipates that both hospitals and ASCs will need to reassess their outpatient strategies. This might involve integrating ASCs into their networks or forming new partnerships to maintain control over lucrative procedures.

“Surgery centers are certainly preparing for that in hospitals as well, trying to figure out what their outpatient strategy is going to be...” (10:10)

Looking ahead, Laura emphasizes the importance of ongoing dialogue among healthcare executives to navigate these changes effectively. She points to upcoming CEO and CFO roundtables as critical forums for sharing strategies and fostering collaboration.

Conclusion

The episode wraps up with Laura expressing her commitment to monitoring these evolving trends and their implications for the healthcare sector. She underscores the resilience and innovative spirit of healthcare organizations as they adapt to legislative changes and strive to ensure continued access to care.

“It really will be a critical place for health care executives to connect and understand from each other the way that healthcare is really transforming...” (11:00)

Key Takeaways

• The One Big Beautiful Bill Act (HR1) introduces significant changes that will unfold over the next decade, with substantial financial implications for hospitals, particularly in rural areas.
• Site neutral payment policies aim to equalize reimbursement rates between HOPDs and ASCs, potentially reshaping employment models and financial strategies within healthcare organizations.
• Healthcare systems are responding with strategic partnerships, innovation, and enhanced charitable care initiatives to mitigate the impacts of these legislative changes.
• Ongoing collaboration and knowledge sharing among healthcare leaders are crucial for successfully navigating the evolving landscape.

This episode of Becker’s Healthcare Podcast provides a thorough exploration of critical policy changes and their potential effects on the U.S. healthcare system, offering valuable insights for healthcare professionals and stakeholders.

Transcript

[Chanel Bunger]

Hello and welcome to the Becker's Healthcare Podcast. My name is Chanel Bunger, and today I'm excited to speak with Laura Dearda, vice president and editor in chief at Becker's Healthcare, who joins us weekly to share insights in a healthcare trend she's keeping an eye on. Laura, thank you as always for joining me today. Why don't you take it away and tell us about what you're seeing out there.

[Laura Dearda]

Thank you so much, Chanel. I think one of the things that I wanted to talk about today is some of the impacts that we're seeing from the One Big Beautiful Bill act, or HR1, as it has been signed into law by President Donald Trump on July 4th. After the signing, I know so many hospital health system executives in particular spent the weekend crunching the numbers to try to figure out what the impact is going to be of the final legislation on their organizations and how they can prepare most appropriately. Many of the changes occur over time or will be phased in over two to three years and even out over the next decade in terms of impacts. And so, you know, really looking at what will make a difference for them and how they should start thinking about and planning now for potential changes within Medicaid for ACA enrollment, how they're looking at the providers that they're working with and more. I think the biggest things that we're hearing from hospitals and health systems, whether they're large health systems spanning several states in really multibillion dollar companies or small critical access hospitals that are really just struggling to survive on thin margins and even losing money from year to year, they're really talking a lot about Medicaid and what that could do to more broadly impact their overall financial situation and community in general. We've really seen a lot of challenges in government payers. Obviously, Medicare already has lowered payments in many of the ways that hospitals and health systems expected in the past. And so for especially smaller rural hospitals that are depending on some of the payments for Medicaid, some of those benefits, indirect payments, provider taxes and more, are just really strong, struggling to figure out how they're going to transform themselves and whether it's partnerships, consolidation, adding new service lines, trying to figure out what they can do in order to bring more patients from their community in and make sure they're still able to provide care and coverage. Worst case scenario is that some of these hospitals may not be able to stay open because of the financial stress that these changes could incur. I know there's a 15 $50 billion planned over five years for the Rural Health Transformation Program to mitigate some of these losses. But many feel it's not enough. And unless states step in in a more meaningful way, they could have some real challenges ahead. Secondly, we're just really hearing from a lot of organizations that they're trying to figure out how they can partner with physician groups, specialty groups, as well as primary care to provide additional services, make sure they're modernizing their facilities, and working well with our community groups as well as technology companies to figure out how they can best develop the hospital of the future that can deliver care despite any of these disruptions to the broader policies in patients overall. And then finally, many organizations are planning for more charitable care, anticipating that, you know, some folks will not be able to keep up with the tighter timeline for Medicaid redeterminations, thinking through how they can continue to evolve. All their emergency departments especially, which can sometimes be overburdened by uncompensated care and people coming in without insurance. So we're already seeing, in some ways, hospitals and health systems from the last couple of years feeling the pinch, have had to do layoffs, service cuts and more, and they're increasing pressure on commercial payers to meet their contractual obligations. So it's been really interesting to kind of hear how a lot of CEOs across the country are thinking about this. Some see it as being, you know, very much a challenge. Others appreciate the fact that there's time, a few years, in order for them to prepare and really see a possibility that some of the full impacts or the full provisions of the bill won't actually come to fruition. So, you know, you don't ever want to depend on hope there. You want to make sure you've got a plan in place. But at the same time, it's possible that things could change between now and in 2020, and then, of course, over the next decade as well. So that's kind of the biggest thing that we're talking about. A lot of challenges, a lot of stress and concern over that. But also at the heart of the conversation just is the true resilience of the healthcare system. Healthcare being an institution for so many communities, looking at ways that the community is continuing to build up hospitals and health systems and invest within, especially rural facilities to keep them open. There's still a lot of innovation. There's still a lot of energy around making sure that, you know, there'll be creativity in space to figure out new ways of delivering care and creative partnerships to make that happen. So we'll keep an eye on that. And continue to share information, share perspectives and what's working well for hospitals and health systems, big health systems, as well as community hospitals and small rural critical access hospitals as well over the next several months. And then of course, at our CEO and CFO roundtable, this will be a huge topic of conversation for many of our panels. I know so many of our speakers will be sharing what they have already done as they've made these assessments and figuring out what they're going to do next at the event. And so it really will be a critical place for health care executives to connect and understand from each other the way that healthcare is really transforming and planning to iterate into this next evolution of what healthcare is going to look like under the one big beautiful Bill Act. So that's, that's the first and foremost thing that we have been talking about and thinking about and trying to navigate for so many of our executives over the last five days or so. And then I also wanted to mention, in June, we had an ASC event that was focused on spine orthopedics and it really had some fascinating discussions around site neutral payments. Dr. Adam Brueggeman, the CEO of Texas Spine center and chair of the American Academy of Orthopedic Surgeons Advocacy Council, spends a lot of time in Washington, D.C. talking about what physicians need in particular to continue to thrive and then advocating for surgery centers, physician groups, and orthopedics in general. And one of the things he mentioned is that conversations that he's having with congressional leaders in lawmakers really point towards the fact that the Trump administration as well as Congress wants to figure out site neutral payments, which could mean a variety of things. But a lot of the policymakers, it sounds like, are leaning towards site neutrality. That would actually lower the rates for hospital outpatient departments to something similar for the ASC. Right now, hopds are paid significantly more than ASCs for the same services because of the facility. Because they're at a hospital, they can command a higher rate because of all the different services hospitals offer. However, for the site neutral payment policies, the administration is really looking to find a way to, to close that gap by lowering what they would pay for hospitals. And so thinking about what that will do on a variety of fronts, you know, for especially the hospital's ability to employ physicians, I know a lot of what they have planned in the past was really being able to supplement the salaries for especially specialists at the hospital and health systems and employing physician groups because they had those higher reimbursement rates for certain procedures. And so knocking that down it could be interesting to see whether they are still plan an employment policy, how they're able to navigate the next contracts with their employed physicians. And if they're not able to extend or increase pay, will that mean employed physicians decide to go private or independent, decide to actually leave the hospital health system and create independent physician groups or join independent physician groups, buy into more surgery centers and change the landscape that way will be really fascinating to see. I think especially as non compete legislation as well has been a policy under scrutiny over the last couple of years. And so in states where non competes are loosening, it would be even easier for physicians to leave their hospitals or health systems and become independent. I think too the other aspect that we were looking at through that lens was what a potential site neutrality would do for GPOs. Group purchasing organizations supply costs as well as wage for nurses as well as the workers at the hospitals in those that they're paying. I know hospitals typically have received higher contracts, are able to get better contracts from GPOs than surgery centers. And you know, surgery centers might be able to negotiate less just because the reimbursement is lost. But now if their pay is similar, how are they thinking about the impact of that on their suppliers, their vendors and what the vendors might need in order to cover a gap in contracting there? So it's just been fascinating to think about that as well as, you know, hospitals are typically now paying nurses quite a bit more than what surgery centers are able to pay. And so if some of this does come into play and they might not be able to increase wages as much as they have been in the past, what does that do for surgery centers and how they might need to think about and adjust their staffing models as well. And so a lot of questions, not a ton of answers quite yet, but it's just truly will be interesting to see over the next couple of years if that's something the administration does get done and pursue in a more serious way than in the past. I know surgery centers are certainly preparing for that in hospitals as well, trying to figure out what their outpatient strategy is going to be, whether they're going to have ASCs as part of their network, whether they're partnering with physicians and what they can do in order to keep some of those procedures within their organization, will it make sense or not? So all sorts of questions there, but we'll definitely keep abreast of that trend too and just excited to kind of keep digging into the ways that this administration is changing policies that really impact healthcare in a meaningful way.

[Chanel Bunger]

Got it. Got it. Well, Laura, I want to thank you, as always, for sharing insights on all these important trends and issues and for joining me on the Becker's Healthcare podcast. Thank you so much.

[Laura Dearda]

Thanks, Chanel. It's always a pleasure.