Tag: Reimbursement

5 costly mistakes to avoid when building an ASC

Editor's Note Poor planning and rushed decisions derail too many ambulatory surgery centers (ASCs) before they open their doors. In a recent blog post, ASC consultant Emily Spooner outlined the top five errors commonly made during ASC development, offering targeted guidance on how to avoid them. According to the post,…

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By: Tarsilla Moura
August 12, 2025
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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.…

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By: Tarsilla Moura
August 5, 2025
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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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By: Matt Danford
August 4, 2025
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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…

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By: Matt Danford
July 30, 2025
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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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By: Tarsilla Moura
July 23, 2025
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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…

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By: Tarsilla Moura
July 23, 2025
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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…

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By: Matt Danford
July 17, 2025
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CMS 2026 proposed rule: Expanded ASC access, higher payments, tighter quality reporting

Centers for Medicare & Medicaid Services

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…

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By: Tarsilla Moura
July 16, 2025
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Health systems retreat from partnerships to control costs, refocus on core care

Editor's Note Some health systems are cutting ties with long-standing partners to conserve resources, brace for financial uncertainty, and prioritize core clinical services, Modern Healthcare June 26 reports. With looming federal reimbursement cuts and increasing economic pressures, providers are reassessing the value and sustainability of affiliations formed during more stable…

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By: Tarsilla Moura
June 27, 2025
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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…

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By: Matt Danford
June 25, 2025
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