CMS’s 2027 OPPS proposed rule would cut 340B and imaging payments
Medicare payment for 340B drugs and imaging services would undergo notable reductions under CMS’s 2027 proposed rule for the hospital Outpatient Prospective Payment System (OPPS) and ambulatory surgical centers (ASCs). Payment for many services would increase due to budget neutrality requirements, but the net impact of the various changes projects to be negative for most…
House bill would increase tax-exempt hospital reporting requirements
A bill that advanced out of a House committee Wednesday would add significant reporting requirements for tax-exempt hospitals. As passed by the Ways and Means Committee, the Tax-Exempt Hospital Transparency Act includes increased reporting obligations in areas such as community benefit, charity care, the 340B Drug Pricing Program and service-line spending. Requirements would be more…
Medicaid work requirement lawsuit targets CMS exemption rules
A coalition of more than 20 states filed suit to vacate key parts of recent regulations implementing the Medicaid work requirement, arguing that CMS overstepped its bounds. Litigation filed in the U.S. District Court for Massachusetts states that key parts of a recently issued interim final rule with comment period (IFR) deviate from congressional intent…
ACA marketplace enrollment decline puts coverage affordability in focus
The Trump administration released updated 2026 enrollment figures for Affordable Care Act (ACA) marketplace plans, arguing that the year-over-year decrease resulted from efforts to crack down on fraud. Enrollment fell from 22.1 million at the end of 2025 to 19.2 million in February 2026.a The drop-off largely reflects reductions in improper enrollment rather than in…
340B bill would levy various restrictions on participating hospitals
Legislative language overhauling the 340B Drug Pricing Program faces a long and uncertain path in Congress but would have significant implications if some of the provisions become law. A preliminary bill draft released by Sen. Bill Cassidy (R-La.) would tighten oversight of hospitals and contract pharmacies, increase transparency and require 340B discounts to be transferred…
Update: Litigation about the 340B program’s ‘patient’ definition could affect hospital savings
Note: This story is an update to prior coverage. Providers weighing in on potentially disruptive litigation involving the 340B Drug Pricing Program say a ruling in favor of the drug manufacturer would have substantial implications for the program. In a case brought by AbbVie Inc. against the federal government, the central question concerns the definition…
Hospital drug and supply expenses push finance teams to rethink cost strategy
With drug and supply costs continuing to strain margins, hospitals are searching for strategic approaches to mitigate the impact. Drug costs are surging, driven by specialty drugs ranging from GLP-1 products to cell and gene therapies. Citing industry data, Emad Rizk, MD, who recently moved into the top position with Premier Inc., pointed to pharmaceutical…
Medicare funding projections sharpen concerns over access and payment rates
The latest annual report on the state of Medicare funding reflects a conundrum for healthcare industry stakeholders. Medicare spending on healthcare services is on an increasingly difficult fiscal track, projected to rise from $1.2 trillion in 2025 to $2 trillion in 2035. Yet as acknowledged in the report issued this month by the Medicare trustees,…
Finding the right 5%: How predictive analytics is reshaping population health management
Healthcare organizations face a familiar challenge: identifying which members are most likely to experience clinical deterioration before costly complications occur. As financial pressures intensify and workforce shortages continue, health plans, employers and provider organizations must allocate limited care management resources with increasing precision. The question is no longer whether organizations should stratify risk — it…
Dispute resolution likely to be more disruptive as a result of new rule
A recently released CMS final rule concerning independent dispute resolution (IDR) mediation likely will cause a further bottleneck of No Surprises Act-based appeals, experts said. In the final rule, the fees were set at $15, down from $115 paid before the proposed rule came out. CMS in its proposed rule had originally set the revised…