2027 Medicare OPPS final rule cuts 340B payments, expands site-neutral rates
In the 2027 Medicare final rule for hospital outpatient departments, CMS slightly mitigated several issues that providers had cited regarding the proposed version of the rule. Those steps have not assuaged stakeholder concerns about the rule’s impact on Medicare reimbursement in the hospital outpatient sector. CMS finalizes 2.3% outpatient payment increase and 2% recoupment Hospitals…
Healthcare policy after the 2026 midterms
Although the Nov. 3 election results gave Democrats control of Congress for the next two years, the prospects for sweeping changes to healthcare policy are murky. The Senate could hinder legislative activity because Republicans will have the numbers to block bills from proceeding to formal votes. Bills require a 60-vote majority to avoid filibusters, although…
The latest on GLP-1 coverage and how HFMA’s New Mexico Chapter is tackling healthcare’s biggest challenges
After a brief news update, Nick Hut talks with Lauren Remspecher, a senior director with the Purchaser Business Group on Health about the population health benefits of GLP-1s and how employers are covering them. Erika Grotto talks with Kris Brumley, the current president of HFMA’s New Mexico Chapter. FTC Issues Letters Warning Hospitals Against Deceptive…
Court vacates CMS medical frailty restriction in Medicaid work requirement
In a ruling considered favorable to Medicaid beneficiaries and providers, a federal court sided with plaintiffs’ argument that CMS exceeded its authority in regulations defining the medical frailty exemption to the Medicaid work requirement. An Oct. 29 summary judgment by a Massachusetts federal court vacated regulatory language that would have complicated the task of deciding…
ACA marketplace subsidy verification rule would reduce enrollment starting in 2028
Proposed annual verification processes for Affordable Care Act (ACA) marketplace insurance subsidies could prove disruptive to returning enrollees. A CMS proposed rule would implement provisions of H.R. 1 (also known as the One Big Beautiful Bill Act or the Working Families Tax Cut Act) starting with 2028 open enrollment. An enrollee applying for subsidies with…
Hospital financial performance improves as Medicaid funding risks grow
Going back to early 2026, hospital and health system financials have started to reflect industry responses to H.R. 1, the One Big Beautiful Bill Act (OBBBA). In new reporting (registration required) from Strata Decision Technology on first-half 2026 trends, health system financial performance improved over the six-month period, even as margins remained tight. After falling…
2027 Medicare Advantage Star Ratings show gains in high-rated plan enrollment
More than 70% of beneficiaries in Medicare Advantage (MA) plans that include prescription drug coverage are in contracts rated at least four stars out of five, according to CMS’s Star Rating release for 2027. Those plans are in line for quality-bonus payments and in 2028 will receive higher rebates that are used to support supplemental…
Elevance Health brings commercial site-neutral payment to hospital claims
Elevance Health is moving site-neutral payment concepts into commercial reimbursement, with a Sept. 29 announcement setting the stage for constraints on hospital payment. The insurer said it would incorporate a series of new billing policies “intended to address increasingly common situations where care provided at an off-campus location is billed at a higher hospital rate.”…
Value-based care and alternative payment models: What they are and how they work
Value-based care (VBC) is an approach to healthcare that seeks to improve the quality, outcomes and experience of care while managing its cost. Rather than rewarding healthcare organizations solely for the volume of services they provide, value-based arrangements link some or all payment to measures of quality, outcomes, utilization or total cost of care. The…
James Mathews: Why site-neutral payment does not mean eliminating the IPO list
During my tenure at the Medicare Payment Advisory Commission (MedPAC), the Commission recommended that Medicare implement site-neutral payment for certain services and procedures in defined circumstances. The premise was sound at the time, but ideas about this approach have evolved in recent years — to the point that it may have led CMS to the…