CMS finalizes steeper Medicare physician pay cuts for 2027, moves ahead with RPM vendor restrictions

The Centers for Medicare and Medicaid Services finalized sweeping Medicare payment reforms it says will shift the program from volume-based "sick care" toward prevention, primary care and accountable care. The 2027 Medicare Physician Fee Schedule rule includes a roughly 2% reduction in baseline physician payment rates with targeted increases and new payment...

NAACOS Award Winners Share Keys to Success

The National Association of Accountable Care Organizations (NAACOS) recognized three ACOs with awards at its fall meeting last week. During an Oct. 16 panel session, representatives from the award winners, Bryan Health Connect ACO in Nebraska, Ochsner Accountable Care Network in Louisiana, and TriValley Primary Care in Pennsylvania, discussed some of their accomplishments and lessons learned in accountable care...

AHA, MHA, and Four Safety-Net Hospitals File Suit to Stop Costly 340B Rebate Program From Harming Hospitals and Patients

The American Hospital Association (AHA), the Maine Hospital Association (MHA) and four safety-net hospitals filed a lawsuit in the United States District Court for the District of Maine challenging changes by the Department of Health and Human Services (HHS) to the 340B Drug Pricing Program that would expand the use of a proposed rebate...

Patient-facing innovation requires a new approach to ROI

As health systems invest in AI and other patient-facing technologies, leaders are broadening the business case beyond short-term financial returns to include patient loyalty, market share, workforce satisfaction and long-term organizational value. In fact, the pace of patient-facing innovation is testing conventional ROI thinking among healthcare leaders, and it’s changing the way in which CFOs guide...

Coalition to Share Lessons Learned in CMMI’s ACCESS Model

Four stakeholder groups in the accountable care space have formed a coalition to help guide developments involving the Center for Medicare and Medicaid Innovation’s recently launched ACCESS Model. Accountable for Health, America’s Physician Groups, the Health Care Transformation Task Force, and the National Association of Accountable Care Organizations (NAACOS) will share insights and lessons learned...

CMS eyes Medicare pay cuts for 1,100+ lab codes: 8 things to know

CMS is preparing to reset Medicare laboratory payments in 2027 after the agency said new private-payer data showed the program is paying substantially more than commercial insurers for many clinical tests.  The agency said preliminary rates under the Clinical Laboratory Fee Schedule are about 16% lower on average than 2026 Medicare rates and estimated the changes could save taxpayers about $1...

States are betting millions on remote monitoring. Providers, tech groups say proposed Medicare policy could undercut it

States are pouring billions into remote monitoring and virtual care infrastructure to address rural access gaps, but federal reimbursement changes could undermine the financial model many providers use to deliver those services. In July, the Centers for Medicare and Medicaid Services (CMS) proposed changes to remote physiologic monitoring...

Costs tied to No Surprises Act's IDR process hit $22B in 2025, study finds

Total costs associated wth the No Surprises Act's dispute resolution process reached $22.4 billion at the end of 2025, according to a new analysis. Researchers at the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy dove into the latest public data on independent dispute resolution (IDR) from the federal government, and found that of that...

AI Is Only as Good as the Workflow Behind It

Healthcare organizations are rapidly investing in ambient AI and clinical documentation technologies to reduce administrative burden and give nurses more time at the bedside. Early implementations have demonstrated meaningful reductions in documentation time. While AI can accelerate documentation, layering this technology onto outdated workflows risks perpetuating inefficiencies. The next phase of innovation...

CMS' mandatory VBC programs brought substantial administrative costs for hospitals: study

Participation in mandatory value-based payment programs is tied to higher annual administrative costs for hospitals, according to a comparative study published in JAMA Health Forum. The analysis reviewed Medicare cost report data for different types of hospitals that did and did not participate in three mandatory programs initiated by the Centers for Medicare and...