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%…
Medicare faces automatic cuts as GOP tax law triggers PAYGO penalties
Editor's Note President Donald Trump’s “One Big Beautiful Bill” could trigger more than $500 billion in Medicare cuts over the next decade unless Congress waives automatic spending rules, according to a July 9 article in Modern Healthcare. As detailed in the article, the legislation’s projected $3.4 trillion increase to the…
CMS vision shifts as agency halts funding for state programs
Editor's Note The Centers for Medicare & Medicaid Services (CMS) will no longer approve federal matching funds for designated state health programs (DSHPs) and designated state investment programs (DSIPs) that are not directly related to Medicaid services. According to the April 10 announcement, the decision aims to preserve the core…
Study: Preop mental health assessment improves postop outcomes for older patients
Editor's Note Preoperative mental health assessment significantly increases the odds of a postoperative “textbook outcome” for older patients, according to research published on March 15 in the journal Surgery. The median age for the patient population analyzed at the time of surgery was 74 years. Focusing on more than 32,500…
Costs drop, access expands for GLP-1 weight loss drugs
Editor's Note Access to GLP-1 medications is improving as manufacturers, insurers, and policymakers address high demand, costs, and coverage challenges, Becker’s Hospital Review reported December 13. As detailed in the article, Eli Lilly’s partnership with telehealth company Ro now allows patients to obtain Zepbound prescriptions online and receive shipments directly…
Medicare Advantage insurers prioritize profits over patients, Senate reports
Editor's Note A Senate report reveals that Medicare Advantage insurers are increasingly prioritizing profits over patient care by ramping up the use of prior authorization to deny necessary services, particularly post-acute care, for older adults, Becker’s Hospital Review reported October 17. In May 2023, the Senate Permanent Subcommittee on Investigations…
Medicare policy on prior authorization falls short on shifting outpatient surgery trends
Editor's Note A Medicare policy introduced in 2020, which requires prior authorization for certain procedures done at hospital outpatient departments (HOPDs), has not significantly reduced the volume of surgical procedures being done at these facilities, reports a study by Michigan Medicine, University of Michigan, published on October 9. The policy,…
CMS proposes $2 Drug List Model to reduce out-of-pocket costs for Medicare recipients
Editor's Note CMS has taken the next steps in making prescription drugs more affordable for Medicare recipients, according to an October 9 report from The US Department of Health and Human Services (HHS). The proposed Medicare $2 Drug List Model, developed in line with President Biden’s Executive Order 14087, aims…
Medicare drug price negotiations to save $6 billion in first year
Editor's Note Medicare’s first negotiations on 10 top-selling prescription drugs for older Americans will save the US government $6 billion in the first year, according to an August 15 article in Reuters. Enabled by President Joe Biden’s 2022 Inflation Reduction Act, negotiations for drugs used by Medicare—which covers 66 million…
Vertical integration favors HOPDs over ASCs
Editor's Note Medicare and patient out-of-pocket costs are rising as vertical integration results in more procedures moving to hospital outpatient departments (HOPDs) than to ambulatory surgical centers (ASCs), Becker’s ASC Review reported on August 8. The article summarizes a study published July 25 in Science Direct. Described as "physician vertical…
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