Provider Costs and Billing Reform

Cost-growth benchmarks are intended to curb health care spending, but they are often insufficient on...

Texans are struggling to manage high and rising health care costs. In their latest State Spotlight, ...

Increasing concerns about prior authorization abuses have resulted in new federal and state reforms ...

High and unexpected charges like facility fees continue to drive patients away from care. In this bl...

Hospitals provide essential care, but their financial realities differ dramatically: some opera...

For-profit entities are buying up health care practices and insurers, and corporate strategies aimed...

On June 17, 2025 Georgetown Center on Health Insurance Reforms (CHIR) hosted a policy briefing on st...

In this May 31, 2024, webinar, we were joined by Kim Cammarata, Senior Assistant Attorney General wi...

This brief explores policy opportunities such as price regulation, competition, transparency, and enforcement reforms to improve health care affordability.

Through a collection of fact-sheets on hospital payment streams, various designations, and key sources of information, this guide offers a starting point to understand the organizational and financial differences across hospitals in the United States. This document provides key questions to ask a hospital – about ownership, type of care, location, type of patients, teaching status, and alternative payment – the answers to which can help better understand the regulations under which a hospital operates, the funding streams it may have available, and other factors that influence its business practices and financial status. This document overviews key terms, concepts, and measures related to hospital revenue from three payment types: Medicare, Medicaid, and commercial insurance. This series of fact sheets describe how a hospital’s organization form influences its business and financial operations, eligibility for federal programs, and level of government oversight and public reporting requirements. This series of fact sheets overviews subsection (d) hospitals (“general acute care hospitals”) and Medicare-recognized specialty hospitals, explains how these hospitals are treated under Medicare and 340B, and provides descriptive statistics for each hospital type. This series of fact sheets explain how a hospital’s location influences how and what it gets paid by Medicare, as well as explains how each type of rural hospital is treated under Medicare and 340B, and provides descriptive statistics for each rural hospital type. This series of fact sheets describe how “safety-net hospitals” – Medicare and Medicaid disproportionate share hospitals (DSH) and 340B hospitals – quality and are paid under their respective federal programs, and provides descriptive statistics for each program. This series of fact sheets define graduate medical education and describe U.S. teaching hospitals with key descriptive statistics on institutional characteristics. This series of fact sheets defines the goals of alternative payment models and describes the Medicare Shared Savings Program as well as a range of Centers for Medicare & Medicaid Services Innovation Center models. This document identifies key sources for understanding an individual hospital’s ownership, regulatory and payment classification, and its financial, operational, and quality performance beyond what is covered in the What to Ask (About) a Hospital guide.

This issue brief focuses on how cost-sharing requirements affect access to insulin-requiring diabetes care and examines state policy options to improve the affordability of diabetes medications, devices, and supplies in the private insurance market. This issue brief focuses on how prior authorization practices affect access to insulin-requiring diabetes care and outlines state policy options to improve the use of utilization management for clinically appropriate diabetes treatment. This state spotlight examines how Colorado and the District of Columbia used standardized plan design and stakeholder engagement to reduce cost-sharing and expand access to clinically recommended diabetes care.