Healthcare providers express cash flow concerns under new 340B rebate model
Editor's Note Healthcare providers could experience significant cash flow and operational changes under a new voluntary pilot program that fundamentally alters how the nation's second-largest drug payment program operates, according to an August 11 article in Modern Healthcare. As detailed in the article, The Health Resources and Services Administration announced…
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.…
Nearly half of hospital patient harm events go unreported, OIG reveals
Editor's Note Nearly half of hospital harm events—particularly surgical events—were not captured by reporting systems, according to a July 30 TechTarget report on new findings from the Office of Inspector General (OIG). The OIG report examined 299 harm events experienced by a nationally representative sample of 770 Medicare patients discharged…
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…
Nurse, technician report reveals burnout, underpayment, safety concerns
Editor's Note A recent article from HIT Consultant highlights findings from Incredible Health’s 2025 State of US Nursing & Technicians Report, revealing mounting strain across the nursing and healthcare technician workforce. Reportedly based on insights from more than 1 million professionals, findings include: 71% of nurses report that staffing shortages…
Study: Physician organizational affiliation impacts procedure locations, costs
Editor's Note Hospital-employed physicians are least likely and private equity (PE)-affiliated physicians most likely to provide care in lower-cost ambulatory surgery centers (ASCs) or offices, according to a study published July 24 in the Journal of Market Access & Health Policy These care site differences translate to substantial variation in…
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…
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