MedPAC says hospital payments are sufficient, urges better safety-net targeting
Medicare payment to hospitals is broadly adequate but should be better targeted for lower-resourced facilities, according to a formal recommendation by the Medicare Payment Advisory Commission (MedPAC). In its annual report to Congress on Medicare payment policy, MedPAC said 2027 inpatient and outpatient payments should increase in accordance with the statutory formula and do not…
Hospitals targeted in healthcare affordability debate on Capitol Hill
Large employers are looking to put much of the impetus for improving healthcare affordability on hospitals, according to congressional testimony Wednesday. “Many of the biggest cost increases are driven by hospitals and health systems and can be addressed today,” Elizabeth Mitchell, president and CEO of the large-employer coalition Purchaser Business Group on Health (PBGH), said…
CMS details implementation of Medicaid 6-month eligibility checks under the OBBBA
CMS has issued guidance on how Medicaid expansion states should implement the higher-frequency eligibility redeterminations as required under the One Big Beautiful Bill Act (OBBBA). Starting in 2027, states must conduct eligibility checks of most adults in the expansion population every six months, up from annually (the guidance refers to the 2025 law as the…
The future of accountable care
Nick Hut and Katie Gilfillan discuss a new accountable care organization model on deck for 2027.
Hospitals can use 2026 to prepare for CMS TEAM bundled payment risk
In what amounts to a dress-rehearsal year, hospitals participating in CMS’s mandatory Transforming Episode Accountability Model (TEAM) should take the opportunity to prepare for the high stakes that loom. TEAM, a five-year bundled payment model that is obligatory for nearly 750 hospitals in 188 selected markets, is upside-only in its first year. The ante rises…
Study details how OBBBA Medicaid cuts will restructure state budgets
A handful of states may gain financially because of the Medicaid provisions legislated in the 2025 reconciliation bill known as the One Big Beautiful Bill Act (OBBBA), according to a new study. Results of an analysis by RAND Health include the finding that state Medicaid budgets will fall by $664 billion between 2025 and 2034,…
GAO examines No Surprises Act payment and network trends
Recent trends seen as a consequence of the No Surprises Act (NSA) include a moderate increase in the share of providers going in-network for some services, according to a report by the Government Accountability Office (GAO). Such a development was a secondary goal of the 2020 year-end legislation and could belie concerns that the large…
Medicare GME funding reform debate focuses on rural hospitals
Better-targeted funding is essential to ensure the clinical talent pipeline meets the needs of hospitals in rural and underserved areas, according to insights at a recent congressional hearing. Phelps Health, a rural Missouri hospital, has benefited from federal and state planning and development grants that enabled the launch of a family medicine residency with enhanced…
Hospitals mount response as site-neutral payment policy progresses
Hospitals and their advocates think the concept of site-neutral payment is gaining enough traction in policy circles that a strategic response is warranted. One step in attempting to stanch the apparent momentum of site-neutral policies is the release of a new report that finds recommended approaches would cut hospital payments by $182 billion over 10…
CMS provides more leeway to Medicaid state-directed payments before new limits kick in
March 23 update The Committee for a Responsible Federal Budget (CRFB), which advocates for deficit reduction, issued an analysis criticizing the extent to which states are capitalizing on the grandfathering clause to maintain higher rates for state-directed payments (SDPs) through 2027. CRFP reported that Illinois and Texas have increased their SDP rates by 50% since…