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…
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)…
Surgical patients see better outcomes but face longer hospital stays, AHA and Vizient report finds
Editor's Note Hospitalized surgical patients in 2024 were nearly 20% more likely to survive than expected compared to 2019, according to an August 5 analysis from the American Hospital Association (AHA) and Vizient. The report credits safety improvements such as reductions in infections, falls, and major complications, even as surgical…
DOJ task force, insurers target ASC barriers with parallel reforms
Editor's Note Federal regulators and major insurers are independently moving to ease long-standing burdens on ambulatory surgery centers (ASCs), potentially reshaping the regulatory and administrative landscape in which perioperative leaders operate. According to Ambulatory Surgery Center News June 23, ASC stakeholders are actively engaging with the new Anticompetitive Regulations Task…
Major insurers pledge prior authorization reform
Editor's Note Nearly 50 major US health insurers—including UnitedHealthcare, Aetna, Cigna, Elevance, and Humana—have pledged to reform prior authorization practices, with the goal of easing administrative burdens and improving access to care, according to a June 23 article in Healthcare Dive. As detailed in the article, the announcement came from…
Cardiology efficiency, orthopedic revenue surge as ASCs navigate growing complexity
Editor's Note HST Pathways’ most recent industry report, discussed on the Advancing Surgical Care Podcast by HST CEO David Thawley and Bill Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), offers insights into cardiology and orthopedic procedures done in ambulatory surgery centers (ASCs) in 2024, Ambulatory Surgery Center News…
Montana legislators' prior authorization reform push mirrors national trends
Editor's Note Montana legislators are moving to restrict health insurers’ use of prior authorization as frustration over the practice mounts nationwide, KFF News reported February 13. The outlet reports that two Democratic and Republican lawmakers have introduced or are drafting bills for the 2025 Montana Legislature to limit these insurer-mandated…
Cigna ties executive pay to patient experience
Editor's Note As part of a larger initiative to ease access to care, insurance giant Cigna is tying compensation for senior leadership directly to customer satisfaction. Modern Healthcare reported the news February 3. The shift is part of a multi-pronged approach that also includes overhauling prior authorization requirements and limiting…
Providers push back on insurance cost-cutting hurdles
Editor's Note Escalating administrative hurdles from insurers are heightening tensions between healthcare payers and providers who criticize the measures for threatening patient care, Modern Healthcare reported January 22. According to the article, policies attracting criticism include stringent prior authorization rules, claims denials, and new fees for appeals. For their part,…
GOP-controlled Senate to prioritize drug pricing, health agency reform
Editor's Note Republicans secured a 51-seat majority in the US Senate after victories in Ohio and West Virginia, promising a power shift that will see GOP leaders shaping decisions on pressing issues like drug pricing, public health agency reform, and rural healthcare. On November 6, STAT published an overview of…
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- Targeted intraoperative radiation slashes pancreatic cancer recurrence to 5%
- Ambient AI reshapes nursing workflows and boosts patient interaction
- Session: Developing a complex spine and total joint service line program in the ASC
- Session: The importance of having a comprehensive plan to prevent workplace violence in ASCs
- Session: Automate to elevate—Streamlining pre-, postoperative processes for better outcomes in ASCs
- Transparent oversight is key to safe surgical innovation
- New patient tool for seeking quality care includes surgery
- Review: Top reasons for perioperative nurse turnover intention
- ASCs look abroad for staffing, but new $100,000 visa fee threatens access to global talent