Rules and Regulations
CMS issues new guidance on Medicaid funding
Editor's Note The Centers for Medicare & Medicaid Services (CMS) issued a letter on Medicaid funding November 17 with preliminary guidance for states regarding the implementation of new federal requirements on health care-related (provider) taxes in Medicaid. Per the letter, which was described in a news release at CMS.org, the…
Transparent oversight is key to safe surgical innovation
Editor's Note Unchecked surgical innovation can harm patients, derail careers, and erode trust, Bulletin of the Royal College of Surgeons of England October 31 reports. Failures to properly evaluate and monitor new or modified procedures have led to patient harm, surgeon suspensions, and even criminal convictions, per the article, which…
Workshop: Mastering The Joint Commission standards and CMS regulations
Editor's Note Hospitals that succeed in surveys are those that “hardwire safety so you’re not ramping up and down,” said John R. Rosing, MHA, FACHE, executive vice president and principal of Patton Healthcare Consulting. Speaking at the OR Manager Conference, Rosing reminded perioperative leaders, “If we’re really about providing quality…
CMS launches 6-year model to curb wasteful Medicare spending with AI-driven reviews
Editor's Note The Centers for Medicare & Medicaid Services (CMS) announced the launch of a new model using artificial intelligence (AI) to target unnecessary Medicare spending, the agency reported in an October 17 update. The voluntary model will run from January 1, 2026, through December 31, 2031, and aims to…
CMS narrows surveys to immediate jeopardy, harm during shutdown
Editor's Note The Centers for Medicare & Medicaid Services (CMS) has activated shutdown rules that confine Medicare survey and certification work to health and safety essentials, according to an October 21 memo from the agency. Per the revised memorandum, excepted work during the federal shutdown includes investigations of complaints and…
AI-driven CMS pilot model could slow ASC care despite fraud-fighting goals
Editor's Note The Centers for Medicare & Medicaid Services (CMS) is enlisting artificial intelligence (AI) to combat wasteful spending, but ambulatory surgery centers (ASCs) warn the plan could slow care and increase administrative strain, Ambulatory Surgery Center News October 20 reports. The agency’s new Wasteful and Inappropriate Service Reduction (WISeR)…
UnitedHealthcare anesthesia cuts spark backlash over patient access risks
Editor's Note UnitedHealthcare’s 15% cut to certified registered nurse anesthetist (CRNA) reimbursements has ignited strong opposition from anesthesia leaders who warn the policy could endanger patient access to safe, affordable care in rural and underserved areas, Nurse.org October 14 reports. On October 1, UnitedHealthcare implemented the new policy, reducing payments…
Telehealth in limbo: Providers split on continuing Medicare services during shutdown
Editor's Note Telehealth providers are divided over whether to continue serving Medicare patients after reimbursement expired alongside the federal government shutdown, Modern Healthcare October 9 reports. The impasse has forced organizations to weigh patient access against financial risk, with many issuing advance beneficiary notices warning patients they may be responsible…
States take aim at outpatient facility fees driving higher commercial health costs
Editor's Note States are sharpening their focus on outpatient facility fees, using new data and reporting mandates to expose how these charges inflate commercial healthcare spending, HealthAffairs October 6 reports. Specifically, Colorado, Maine, Connecticut, and Washington have launched varied but increasingly sophisticated efforts to monitor when and where hospitals bill…
Nearly half of US physicians now work for large systems: GAO links consolidation to higher costs
Editor's Note Physician independence continues to decline as hospitals, insurers, and private equity firms expand their ownership of medical practices, according to a US Government Accountability Office (GAO) report published on September 22. The report found that 47% of physicians were employed by or affiliated with hospital systems in 2024,…
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