Medicare Advantage patients see lower perioperative costs than traditional Medicare peers
Editor's Note Surgical episodes for Medicare Advantage (MA) patients cost less and used fewer resources than those for traditional Medicare (TM) beneficiaries, according to a JAMA Health Forum study published August 1. Researchers analyzed 1.18 million procedures performed on 1.11 million beneficiaries and found 30-day episode costs were 3.1% lower…
Hospital-affiliated doctors drive highest costs by avoiding lower-cost sites
Editor's Note Patients treated by hospital-affiliated physicians are far less likely to receive specialty procedures in lower-cost settings, while private-equity–affiliated doctors are the most likely to steer patients toward these options, Ambulatory Surgery Center News August 12 reports. The findings come from a Mount Sinai study that examined physician affiliation,…
Largest US healthcare fraud case reveals billions in false Medicare, Medicaid claims and vast schemes nationwide
Editor's Note The US Department of Justice (DOJ) has conducted the largest healthcare fraud takedown in US history, charging 324 individuals, including 96 licensed medical professionals, in schemes totaling more than $14.6 billion, HealthCare Business News July 8 reports. The nationwide crackdown involved 50 federal districts and 12 state attorneys…
Mind the gap: Why Medicare pays ASCs less than HOPDs—and what that means
For decades, ambulatory surgery centers (ASCs) have shown their ability to deliver high-quality surgical care at substantially lower cost than hospital outpatient departments (HOPDs). ASCs achieve these savings through leaner operations, streamlined staffing models, and specialty-focused efficiencies, not by compromising safety or outcomes. Studies consistently highlight procedures performed in ASCs…
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…
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