Navigating H.R.1 (OBBBA) with Clarity and Confidence - You and We Can Do This Together!
H.R. 1 – the One Big Beautiful Bill Act (OBBBA) – is reshaping the operational and financial landscape for hospitals. Change on this scale can be frightening, especially when mandates, reimbursement models, and compliance requirements feel like moving targets.
At the start of any big regulatory change, more details will keep coming in—and that will help clear up the uncertainty. One thing is certain: OBBBA mandates over $1 trillion in cuts to federal healthcare programs. The key is to keep moving, stay focused, and make sure your team is pulling in the same direction.
Consider the following framework to assist as you move from that first reaction to a more informed action.
Step Back and Reset
- Don’t become paralyzed—that’s just the first reaction.
- Take a deep breath; it’s going to be okay. Your leadership presence sets the tone. Even before all the answers arrive, showing calm confidence reassures staff, board members, and community stakeholders.
Engage Specialists Early (time is of the essence)
Bring in expertise to accelerate clarity and de-risk execution:
- Regulatory & Compliance: Interpret OBBBA mandates for your facility type.
- Finance & Revenue Cycle: Model reimbursement impact and update billing protocols.
- Operations & Clinical Leadership: Assess workflow and staffing impacts.
- IT & Data: Ensure reporting systems can capture and submit new compliance data.
Adapt as Details Emerge
With OBBBA, CMS, state agencies, and industry associations will release clarifications over time. Ask regularly:
- What do we know now about operational and financial requirements?
- What’s coming next and when?
- What is unknown, and how do we build flexibility into our plans?
This shifts the mindset from “we can’t act yet” to “we are acting on the best current data and adapting as we go”… (and as soon as fast as we can).
Focus on Decision-Ready Data
Focus on the essentials that directly impact hospital operations, revenue cycle and all sources of revenue generation:
- CMS and state-level implementation timelines
- Reimbursement changes (i.e., DRG adjustments, bundled payment rules, outpatient procedure shifts)
- Staffing and credentialing implications
- Capital and technology requirements for compliance reporting
- Current operational baselines: volumes, payor mix, case mix index, and margin by service line
Prepare Scenarios to Evaluate Potential Impact
Model the financial and operational outcomes under multiple conditions to reflect the impact of the reductions in federal funding:
- Best case: Minimal disruption, reimbursement rates favorable to current service mix.
- Base case: Moderate revenue impact with manageable operational adjustments.
- Worst case: Service line losses, staffing shortages, or major compliance investments required.
Stress test against:
- Case mix changes (inpatient vs. outpatient shifts)
- Revenue cycle lag due to payor policy updates
- Staffing, medical supplies and pharmaceutical cost escalation
Make an Informed, Timely Decision
Perfect clarity may never come before deadlines. Use clear criteria to decide:
- Compliance certainty
- Financial sustainability
- Patient access and quality of care
- Operational feasibility
- And most importantly, sources of significant new cash to offset the impact of H.R. 1…. as soon as possible.
Document your rationale so you can adjust quickly as guidance evolves.
Implement with Control and Measurable Outcomes
- Pilot where possible (i.e., select service lines first).
- Assign a single accountable owner for OBBBA compliance tracking.
- Communicate clearly to physicians, staff, and community stakeholders.
- Track metrics at 30/60/90 days: revenue shifts, denial trends, compliance reporting accuracy, staffing productivity.
Healthcare has gone through big changes before, but not this big! The hospitals that come out ahead aren’t the ones waiting for perfect answers—they are the ones that use the best information they have, adjust as they go, and keep their mission front and center.You/We got this!
Learn more about our Strategic Advisory Solutions
For more information, please contact:
William N. Wildridge III, CPA | CEO/Managing Partner
