Headwinds and Opportunities: Inside THA’s Managed Care & Finance Summit

Texas hospitals are facing constant financial, regulatory and reputational pressures that demand both urgency and strategy. Over two days at THA’s inaugural Managed Care & Finance Summit, health care executives, attorneys, policy advocates and financial experts gathered to confront these challenges head-on. In each conversation, one theme persisted – hospitals can no longer afford to be reactive.

Reputational Turning Point

The bridge between the public and hospitals is ready to be reinforced; new polling presented by Isaac Squyres, senior partner at Jarrard, revealed chances with the public to build confidence as worries grow about the future of health care.

The cost of care was the main concern – nearly 59% of Americans report having difficulty paying medical bills, and many have delayed or forgone care due to financial barriers.

“We have a path forward to build trust,” said Squyres. “We have to get off defense and be on the offensive.”

The challenge is how that story is told. For instance, shifting from talking about “community benefit” to talking more about “community impact.” The distinction matters, as “community impact” resonates more with the public and shifts perceptions of hospitals. Nearly nine in 10 Americans say they expect to hear from provider organizations on health care policy, indicating an opportunity for hospitals to be a source of information on policy issues affecting the communities they serve.

Under the Microscope: Community Benefit

That narrative is increasingly crucial as the scrutiny on non-profit hospitals’ community benefit reporting intensifies. Debbie Ernsberger, principal partner at PYA, recapped the historical evolution of hospitals’ Form 990 from the introduction of Schedule H in 1998 to the 2025 congressional hearing on non-profit hospitals’ tax-exempt status.

At the heart of the problem? Hospitals are being judged by a benchmark that was inconsistent and not uniform. “Why are we not all using the same data set? Everyone is pulling something different,” said Ernsberger.

According to Ernsberger, the hospitals best positioned to withstand public and political scrutiny are those who have already built an internal story, documented their work and are showing community impact. Hospitals should internally bring together teams across finance, compliance and community health to bring fresh eyes and direct these narratives. “Dollars are important, but we need to be measuring health impacts and clinical outcomes,” she said.

Mounting Pressure: Medicare Advantage

No issue generated more urgency among the summit’s attendees than Medicare Advantage (MA). While MA plans are lawfully required to cover any benefit that traditional Medicare covers, they cannot deny coverage based on internal criteria not found in traditional Medicare. Improper denials, prior authorization abuse and rapid changes from post-payment to pre-payment auditing are straining hospital finances and threatening patient care.

Hospitals’ common challenges include:

Authorization reversals after approval
Lost or disregarded documentation
Prepayment reviews delaying reimbursement for months
Readmission denials applied inconsistently

The result is more than administrative burden – it involves risk to patient care and hospital stability.

Michael Hildebrand, senior vice president, public, community and rural health systems practice deputy at Jarrard, said, “We have to be aggressive, more aggressive than the payers.” The tools available to hospitals include the Centers for Medicare and Medicaid Services, Texas Department of Insurance complaints, peer-to-peer reviews, formal appeals and renegotiation or contract termination.

New Obligations, New Leverage

Price transparency requirements effective at the start of this year are reshaping both regulatory compliance and contract negotiation strategy. With over 14 trillion rows of payer pricing data now publicly available and growing, hospitals that know how to use this data will have an opportunity to negotiate with an advantage. The message on price transparency was clear: this data is a two-edged sword.

Alicia Faust, principal at Forvis Mazars, and Jonathan Buchanan, consulting director at Forvis Mazars, covered several urgent compliance items. As of April 1, CMS may penalize hospitals that are noncompliant with 2026 requirements for reporting MA-negotiated rates on cost reports. Hospitals should review their current reporting processes, identify any gaps in MA-negotiated rate data and take action to ensure compliance before the deadline.

“A huge part of it is making sure your pricing is defensible. Ensure it reflects your line of reimbursement – don’t artificially inflate pricing,” said Faust.

The Legislative Front

A fireside chat featuring Jay Hardaway, Republican nominee for Texas House District 71 and director of legislative affairs & public policy at Hendrick Health System, and Katherine Yoder, vice president of government relations at Parkland Health & Hospital System, offered a candid look at what it takes to influence health care policy in Texas. The next legislative session will be a defining one for health care; Texas carries one of the highest uninsured rates in the nation, Medicaid cuts from the federal government on the horizon and inflation are adding financial pressure to the health care industry.

The consensus from both panelists is that relationship building cannot wait until session begins. “There is no substitute for individuals going in front of their legislators and interacting with them directly,” said Hardaway. Hospitals that educate their local legislators, bring them into the facility and introduce them to staff will be more effective when it counts.

Site-neutral payments, banning facility fees, crackdowns on tax-exempt status and reference-based pricing are all harmful policy proposals expected to resurface during the 90th legislative session.

The panel also addressed the challenge of high legislative turnover. New members offer an opportunity – they haven’t finalized opinions yet and can receive more upfront education. Getting to know legislative staff, connecting personally to local hospital stories and maintaining those relationships through political action committees is essential. As Yoder put it, “Find the connection. [It can be] a daughter born at your hospital, a sister who works there. That’s what makes it real.”

Bottom Line

A few key messages throughout the summit ring clear: payer aggression, regulatory complexities, reputational headwinds and legislative uncertainty are not going away. Yet, despite these challenges, hospitals do have leverage. They have data, community relationships, clinical credibility and patient stories that no payer can compare to.

“Be in the game and conversation,” said Squyres. “We can move the needle.”