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The Hertel ReportThe Hertel Report

  • Home
  • About
    • What We Do
    • THR In the News
    • Our Founder & Publisher
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Summer State of the State Registration is Open!

Summer State of the State Registration is Open!

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Sign up for a Fun Charity Golf Tournament - Sponsored by The Hertel Report & Titanium Healthcare and Benefitting Camelback Rugby and American Cancer Society

Sign up for a Fun Charity Golf Tournament - Sponsored by The Hertel Report & Titanium Healthcare and Benefitting Camelback Rugby and American Cancer Society

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HonorHealth Names Dr. John Neil Successor to CEO Todd LaPorte

HonorHealth Names Dr. John Neil Successor to CEO Todd LaPorte

Arizona News
CMS Opens Up Plan Variety: No Provider Network - No Problem - Highlights of 2027 Marketplace Final Rule

CMS Opens Up Plan Variety: No Provider Network - No Problem - Highlights of 2027 Marketplace Final Rule

CMS Rules
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Study Finds Arizona Uniquely Hit by OBBBA Medicaid Reforms

The One Big Beautiful Bill Act (OBBBA) of 2025 made heavy cuts to the bottom line of state Medicaid programs through a number of small directives aimed at curbing federal spending. Most obvious is the implementation of work requirements for Medicaid...
Arizona News

Update on CMS WISeR Prior Authorization Model and Other AI Healthcare News

Artificial intelligence software is rapidly changing all aspects of the healthcare industry but some are advocating for caution in the face of insurmountable change. This week, people are increasingly turning to AI and social media for health information and House Democrats are turning up the scrutiny of a Medicare demonstration model...
National News

FTC Sues Transgender Care Association

The Federal Trade Commission has filed a lawsuit against an interdisciplinary nonprofit organization that promotes transgender healthcare, the World Professional Association for Transgender Health (WPATH), alleging that the organization has made false claims to sell pediatric medical services. A federal judge intervened against a...
National News

OMB Research Grant Approval Rule Update

Opposition is mounting against a rule proposed by the White House Office of Management and Budget (OMB) that would make federal research grants subject to the approval of a political appointee. House Democrats on the Energy and Commerce Committee wrote a letter to National Institutes of Health Director Jay Bhattacharya on Tuesday...
White Papers, E books, Reports and more

CMS Actuarial Report on National Healthcare Spending

National health spending is accelerating according to a new report from the Centers for Medicare and Medicaid Services' (CMS) Office of the Actuary. The rate of growth is expected to propel total spending to $9 trillion and 20.6% of gross domestic product by 2034. Health spending is estimated to have increased 7.3% to 5.7 trillion in...
National News

Milliman Publishes Study on Digital Health Literacy and Impact on Outcomes

As technological tools advance, patients struggle to keep up with the evolution of medical software required to monitor, communicate and secure their health information. International consultancy Milliman published a white paper on facilitating digital health literacy as a "meaningful determinant of health outcomes." In short,...
Arizona News

Banner Looks to Growth, Value-Based Care With Key Executive Hire

Banner Health has appointed healthcare strategist Mark Whalen as executive VP, chief enterprise growth officer, adding another senior executive focused on expansion, partnerships and value-based care as the Arizona-based system continues to invest in its next phase of growth. Whalen joins Banner from Jefferson, one of the nation's...
Arizona News

What Arizona's New Budget Means for AHCCCS, Rural Hospitals and 988 Services

On Saturday, the Arizona State Legislature adjourned sine die and Governor Katie Hobbs signed an $18.3 billion budget bill into law with strong bipartisan support. The bill includes tax cuts and major curbs on spending while funding critical health and community services. The budget compromise also includes increases in eligibility...
Arizona News

Six Arizona Hospitals Targeted in Federal Price Transparency Crackdown

From the start, hospital price transparency rules, dating back to the first Trump administration, have presented compliance issues for the Centers for Medicare and Medicaid Services (CMS). This week, Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz announced on social media that the...
National News

OIG Finds Widespread Reversals of Medicare Advantage Prior Authorization Denials

Medicare Advantage organizations (MAOs) may be improperly issuing denials for skilled nursing and post-acute care, according to two related reports by the Department of Health and Human Services Office of Inspector General. In the first, MAOs were found to have overturned nearly all prior authorization denials for skilled nursing...
CMS Rules

CMS Signals Tougher Review of Medicaid Waiver Spending

The Centers for Medicare and Medicaid Services (CMS) targets new oversight of Medicaid demonstration project spending authorization through Section 1115 waivers. Nearly all states use demonstration waivers, including Arizona. Late last week, CMS issued the new guidance for upcoming demonstrations beginning January 1, 2027. From that...
National News

OIG Audit Finds Unsupported Stroke Diagnoses in Every Case Reviewed - Potential $462 Million in MA Overpayments

A new report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) suggests that Medicare Advantage plans may have overbilled significantly for unsupported stroke diagnoses. The OIG audit looked at health information for a sample of 97 Medicare Advantage members out of a pool of over 200,000 who were...
Toolkit Offers Roadmap for Bringing Specialists Into Value-Based Care News

Toolkit Offers Roadmap for Bringing Specialists Into Value-Based Care

The next phase of value-based care may depend on specialists. A new industry toolkit from the National Association of Accountable Care Organizations (NAACOS) argues that healthcare organizations must move specialists from peripheral participants to active partners in managing cost, quality and patient outcomes, offering a framework for...
Arizona News

Pima County Helps Win Court Challenge to ACA Exchange Rules

A federal judge has vacated most of the provisions in a Centers for Medicare and Medicaid Services (CMS) rule that intended to significantly alter eligibility and enrollment requirements for the Affordable Care Act (ACA) health insurance exchange. Elsewhere, the agency is requesting feedback for the ACA's essential health benefits...
Arizona News

New Report Flags Arizona Hospitals and Clinics as Medicaid Cuts Loom

In a report released yesterday, Protect Our Care, a nonprofit advocacy group focused on expanding healthcare coverage and defending the Affordable Care Act, identified seven Arizona hospitals at risk of cuts or closure and nine Arizona clinics that have closed or announced closure since the passage of Trump's flagship legislation, The...
Arizona News

Work Requirements, Provider Tax Changes Threaten Hospital Funding & AHCCCS Enrollment

As details come into focus of the federal work requirements that will be imposed on state Medicaid programs next year, health systems are preparing for how the cuts will undermine their bottom line. The new rules, released earlier this month, detail a much stricter work requirement program than initially predicted, and many recipients...
Arizona News

Pima County Joins Lawsuit Against CMS Challenging ACA Exchange Rule Changes

A group of cities and Pima County, Arizona, has filed suit against the Centers for Medicare and Medicaid Services (CMS) for alleged violations of the Affordable Care Act of 2010 and the Administrative Procedure Act of 1946 when the federal agency made rule changes to health insurance exchanges effective next year. The city plaintiffs...
Arizona News

Congress Moves to Halt Medicare AI Prior Authorization Program Active in Arizona

Criticism continues to mount against the Trump administration's plan to use AI-based prior authorization for Medicare claims. The Wasteful and Inappropriate Service Reduction (WISeR) model, now active in Arizona and five other states, has already generated reports of delayed care for seniors since its January launch. On Tuesday, a House...

Ebola Outbreak Could Rival Deadliest Epidemic on Record

The Centers for Disease Control and Prevention (CDC) has assessed that the ongoing outbreak of the Ebola virus in Central Africa could grow to 20,000 cases or more. As the disease continues its relatively unabated spread, the Trump administration's severe cuts to global public health response are brought into stark light. The...

Medicare Advantage Bonuses Face Uncertainty After Major Court Ruling

The Medicare Advantage star ratings system, which determines an insurer's annual bonus for participation in the federal program, may face significant challenges because of a recent court ruling requiring the Centers for Medicare & Medicaid Services (CMS) to recalculate the 2026 star ratings for one insurer, Clover Health. The scope...

Arizona HIE Opts Out of RFK Jr.’s Federal Health Data Project

Contexture, Arizona’s designated health information exchange, confirmed it was approached regarding a federal health data initiative championed by HHS Secretary Robert F. Kennedy Jr., but declined to participate in the national effort seeking access to large-scale health data from state health information exchanges to support federal...

Banner Creates New AI Leadership Role as Healthcare Moves Beyond Pilot Projects

Arizona's largest non-profit health system is elevating artificial intelligence to the executive suite, appointing Dr. John Rares Almasan as senior vice president and chief artificial intelligence, data and infrastructure officer, a newly created leadership position responsible for advancing AI strategy across the organization's clinical...

HonorHealth Expands Scottsdale Footprint as Competition for Arizona Healthcare Consumers Intensifies

Anyone who has circled a hospital parking lot on a 110-degree Arizona afternoon can appreciate HonorHealth's latest addition at Scottsdale Shea, a new 400-space patient and visitor parking garage designed to improve access and navigation across the growing campus. As Arizona's population continues to grow and healthcare systems...

New Series Explores How to Scale Mental Healthcare Through Primary Care - CoCM Saving Thousands Per Patient

A new West Health series examines one of healthcare's most persistent challenges: how to expand access to mental healthcare despite workforce shortages, long wait times, and a fragmented delivery system that often places treatment behind referrals, narrow networks, and months-long delays. The series focuses on the Collaborative Care...

As Family Health Coverage Nears $27,000, Report Calls for Greater Oversight of Healthcare Middlemen

Nearly 165 million Americans receive health coverage through employer-sponsored insurance, yet the average annual premium for family coverage has climbed to nearly $27,000, more than doubling over the past decade and far outpacing inflation, according to a new issue brief from Georgetown University's Center on Health Insurance...
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Jul
17
Fri
2026
9:00 am 2026 Summer State of the State @ Summit Healthcare Conference Center
2026 Summer State of the State @ Summit Healthcare Conference Center
Jul 17 @ 9:00 am – 12:30 pm
2026 Summer State of the State @ Summit Healthcare Conference Center
This year, The Hertel Report Summer State of the State is hosted by our friends at Summit Regional Medical Center in Show Low. Our summer conference features our bi-annual Arizona healthcare market update, as well[...]
Jul
29
Wed
2026
1:00 pm Region 10 HFMA Webinar – Shiftin... @ Webinar
Region 10 HFMA Webinar – Shiftin... @ Webinar
Jul 29 @ 1:00 pm – 2:00 pm
Region 10 HFMA Webinar - Shifting Financial Responsibility: How Medicare and Medicaid Changes are Impacting the Revenue Cycle @ Webinar
Region 10 HFMA Webinar – Shifting Financial Responsibility: How Medicare and Medicaid Changes are Impacting the Revenue Cycle July 29, 2026 at 1:00 PM – 2:00 PM CT Add to Calendar Description Recent changes to Medicare and Medicaid[...]
Aug
27
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2026
8:00 am NABIP-AZ Chapter Annual Conference @ Talking Stick Resort
NABIP-AZ Chapter Annual Conference @ Talking Stick Resort
Aug 27 @ 8:00 am – 6:00 pm
NABIP-AZ Chapter Annual Conference @ Talking Stick Resort
Click HERE to register and stay tuned for more conference details.    
Sep
17
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2026
all-day Az HFMA 2026 Fall Conference @ Venue8600
Az HFMA 2026 Fall Conference @ Venue8600
Sep 17 – Sep 18 all-day
Save the date! Az HFMA 2026 Fall Conference September 17-18th Venue8600 8600 East Anderson Drive Scottsdale, AZ 85255 Stay connected for more details!!   
Oct
21
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2026
all-day AzHHA 2026 Arizona Hospital Lead... @ El Conquistador Hilton Resort in Tucson, AZ
AzHHA 2026 Arizona Hospital Lead... @ El Conquistador Hilton Resort in Tucson, AZ
Oct 21 – Oct 23 all-day
AzHHA 2026 Arizona Hospital Leadership Conference @ El Conquistador Hilton Resort in Tucson, AZ
The AzHHA Foundation’s 2026 Arizona Hospital Leadership Conference will be held Oct. 21-23, 2026, at the exquisite El Conquistador Tucson, A Hilton Resort in Tucson, Ariz. This educational event is dedicated to supporting a vibrant[...]
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