Study: Medicare Advantage surgical episodes cost less, achieve similar quality as traditional Medicare
Editor's Note Medicare Advantage (MA) patients undergoing elective surgery incurred lower costs than comparable patients in traditional Medicare (TM) without higher readmission rates and with no significant difference in mortality rates, according to a study published August 1 in JAMA Health Forum. The findings suggest that MA plans reduce surgical…
Study: Loophole enables urban hospitals to qualify for rural subsidies
Editor's Note Hundreds of urban hospitals have obtained dual urban-rural Medicare classifications since a 2016 policy change, enabling them to qualify for reimbursement programs intended for rural providers. Fierce Healthcare reported the news August 4. As detailed in the article, a study published in Health Affairs by Johns Hopkins and…
Translating MIPS Value Pathways into perioperative practice—What OR leaders need to know
In July 2025, the Centers for Medicare & Medicaid Services (CMS) proposed sweeping changes to the Medicare Physician Fee Schedule for calendar year 2026. Among the most impactful updates is the launch of the Ambulatory Specialty Model (ASM)—a mandatory value-based payment program focused on heart failure and low back pain.…
CMS’s newly finalized TEAM payment model holds hospitals accountable for entire surgical episodes
Editor's Note As part of the Centers for Medicare and Medicaid Services (CMS) newly issued 2026 Final Rule, the Transforming Episode Accountability Model (TEAM) will hold hospitals and health systems accountable for the entire episode of care for major surgeries, from admission through 30 days post-discharge. HIT Consultant reported the…
CMS payment overhaul could cut specialist pay
Editor's Note A “quiet transformation” in how Medicare pays doctors could reduce payments for specialty care, including rates for billing codes associated with surgery, diagnostic imaging, outpatient care, pain management, and orthopedics, Modern Healthcare reported July 22. According to the article, The Centers for Medicare and Medicaid Services (CMS)’ 2026…
Providers call for deeper reform despite CMS proposing payment hikes in 2026
Editor's Note CMS is boosting 2026 Medicare outpatient payments by 2.4%, but provider groups warn the increase barely scratches the surface of mounting financial strain. Alongside the payment bump, the agency is proposing a two-track physician reimbursement model that ties rates to value-based care participation. While some see these moves…
Anesthesia costs squeeze ASCs as staffing shortages, reimbursement gaps widen
Editor's Note Ambulatory surgery centers (ASCs) continue to face a mounting anesthesia crisis: costs are rising, staffing is tightening, and reimbursement is failing to keep pace. Anesthesia payments have dropped 8.2% over the past decade, while provider salaries have risen by as much as 40%, creating a growing financial burden…
Rehab hospitals face scrutiny over safety, profits
Editor's Note Although for-profit rehab hospitals have become highly profitable, a recent KFF Health News report highlights serious safety violations, including patient deaths due to carbon monoxide poisoning, medication errors, and falls. Published July 15, the article delves into recent data and inspections of these facilities, particularly those run by…
CMS 2026 proposed rule: Expanded ASC access, higher payments, tighter quality reporting
Editor's Note The Centers for Medicare & Medicaid Services (CMS) just proposed sweeping changes to the Medicare Shared Savings Program and Physician Fee Schedule for calendar year 2026, including extensive changes to outpatient Medicare policy such as payment increases, expanded procedural access, and new quality reporting updates, as outlined in…
CMS proposes 2026 Medicare pay bump, targets wasteful spending
Editor's Note The Centers for Medicare & Medicaid Services (CMS) has proposed a 3.62% increase to the 2026 Medicare physician fee schedule, according to a July 14 article in Fierce Healthcare. The proposed rule sets the conversion factor at $33.42, up from $32.35 in 2025. The increase reflects a 2.5%…
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