HEALTHCARE
Healthcare Policy Is Financial Strategy.
For hospitals and health systems, a change buried inside a federal payment rule can alter reimbursement by millions of dollars.
Fideo helps healthcare organizations understand those issues, quantify their potential financial impact, organize around common interests and develop a government affairs strategy capable of moving a highly technical policy question into the public-policy process.
WHAT WE WORK ON
Where Policy Meets the Balance Sheet
Medicare Reimbursement
Understanding how federal payment policies affect individual hospitals and health systems.
Rural Hospital Policy
Working on policies affecting the financial sustainability and competitive environment of rural and low-wage hospitals.
Coalition Development
Identifying common problems across hospitals and organizing coordinated advocacy around a defined solution.
Financial-Impact Analysis
Turning complicated reimbursement policy into hospital-level and market-level financial information decision-makers can understand.
Federal & State Advocacy
Developing support among congressional delegations, state policymakers, agencies and affected healthcare organizations.
REPRESENTATIVE WORK
Medicare Area Wage Index Reform
THE CHALLENGE
What was happening?
Medicare uses a wage index to account for geographic differences in hospital labor costs when calculating inpatient hospital payments. CMS's Medicare Geographic Classification Review Board process also permits qualifying hospitals to seek reclassification to another wage area.
Historically, a hospital relying on the standard proximity criteria generally must be within 15 miles if urban or 35 miles if rural of the area to which it seeks reclassification, although other rules and exceptions also apply.
Source: 42 CFR § 412.230 (eCFR)
WHY IT MATTERED
What was at stake?
For hospitals located in lower-wage markets but competing for employees with nearby higher-wage labor markets, those geographic boundaries can create meaningful reimbursement consequences.
THE ANALYSIS
What had to be quantified?
Determining which hospitals may be affected by the existing rule and modeling the potential hospital-level and market-level financial stakes.
Hospital-level figures and coalition modeling are confidential and are not published here.
THE STRATEGY
What was the approach?
Fideo's coalition work has focused on a targeted reform concept that would allow qualifying hospitals in low wage-index markets located within 50 miles of a higher-paid wage area to pursue geographic reclassification while retaining the remaining applicable eligibility requirements.
THE WORK
What did the effort involve?
Bringing affected hospitals and health systems together around a common policy objective, developing congressional, state and stakeholder support, and advancing the issue through federal legislative and regulatory processes.
PUBLIC MILESTONES
What is independently verifiable?
December 2025
Alabama's congressional delegation sent a letter to CMS requesting a less restrictive geographic reclassification mechanism for hospitals in the lowest wage-index areas. The letter specifically proposed expanding the relevant proximity standard to 50 miles from the existing 15-mile urban and 35-mile rural standards.
The delegation stated that more than 50 health systems operating hospitals in the lowest wage-index areas had commented on the FY2026 inpatient payment proposal. The delegation estimated that the proposed reform could produce approximately $460 million in financial benefit to Alabama. That figure is the delegation’s estimate; it is not a Fideo calculation and is not guaranteed.
Source: Alabama delegation letter to CMS, Dec. 5, 2025 (PDF)
Source: Office of Sen. Katie Britt press release, Dec. 11, 2025
2026
In 2026, the Alabama Legislature adopted HJR315, recognizing the federal wage-index effort and encouraging CMS to consider an adjustment through rulemaking.
CURRENT STATUS
Ongoing
The 50-mile proposal is a reform request; it has not been adopted by CMS as of this writing.
WHAT IT DEMONSTRATES
More Than Lobbying.
This work demonstrates Fideo's ability to:
identify a technical regulatory problem;
determine which organizations are affected;
translate complicated reimbursement policy into financial consequences;
organize organizations around a common objective;
build a factual case for policymakers;
coordinate state and federal government affairs; and
remain engaged through a long-term policy process.
THE CONCEPT AT A GLANCE
Proximity Standards for Geographic Reclassification
CURRENT PROXIMITY FRAMEWORK
Urban hospital
15 miles
Rural hospital
35 miles
vs.
PROPOSED TARGETED REFORM
Qualifying low-wage-index hospital
50-mile proximity standard
Other eligibility requirements would continue to apply.
THE STRATEGY
From Technical Rule to Policy Process
01 →
Identify
Determine which hospitals may be affected by the existing rule.
02 →
Quantify
Model the potential hospital-level and market-level financial stakes.
03 →
Organize
Bring affected hospitals and systems together around a common policy objective.
04 →
Build Support
Develop congressional, state and stakeholder support.
05
Advocate
Advance the issue through federal legislative and regulatory processes.
Have a Healthcare Policy Issue With Financial Stakes?
Start with the rule, the hospitals it affects and what it is worth. We will help define the path from there.