Pennsylvania's challenges in sustaining hospital care: Medicaid underpayment, workforce shortages, and medical liability.

As reported by Amy Lotven at Inside Health Policy, the Centers for Medicare & Medicaid Services has lifted the hold for processing most Medicare claims. This means that MACs may wind up needing to reprocess some claims depending on future congressional action… “CMS’ decision means services in areas that fall below the 1.0 geographic practice costs index (GPCI) floor for work relative value units (RVUs) will be paid, although it will be slightly lower, according to Jeff Davis of McDermott+. Congress will now have to decide whether to restore the GPCI floor retroactively.” https://lnkd.in/eDdEPESn

In a column published in today's The Journal Record, McAfee & Taft healthcare attorney Luke Moyer looks at the impact the One Big Beautiful Bill Act on Oklahoma's rural healthcare providers. He writes that “There are likely to be fewer federal Medicaid dollars in rural Oklahoma health systems over the next decade, creating another challenge during an already unprecedented era of rural health strain.” Read more here ▶ https://mt.law/jb9wr

The Centers for Medicare & Medicaid Services's new rule introduces efficiency adjustments and site-based payment changes, reshaping clinician pay. Amid these shifts, it’s vital that reforms support primary care practices that keep patients healthy. Story from Amy Lotven in Inside Health Policy: https://lnkd.in/epiiYJVA

Thank you to the Will Cain Show for having me on to discuss why the Affordable Care Act has driven up healthcare costs in America. It’s pretty simple: The ACA gave tremendous market power to health insurers and corporate medicine including large health systems making it difficult for private practices to compete. It imposed regulatory, documentation, and reporting burdens making private practice viability increasingly difficult. Only 25% of physicians remain independent now with the rest employed by corporate medicine. The ACA also banned physician owned hospitals which have been shown to provide care at lower cost with higher patient satisfaction scores. The unfortunate end result: Massive healthcare consolidation resulting in less competition. And a basic economic principle is that less competition results in higher prices. We need to restore free market forces to fix the cost crisis in US healthcare and level the playing field to encourage competition. Bring back private practice. Bring back physician owned hospitals. This is what our patients deserve. #PrivatePractice #HealthcareReform #HealthcareConsolidation Scott Becker Adam J. Bruggeman, MD, MHA, FAAOS, FAOA Dutch Rojas

🚨 The Patients Over Profit Act (POP Act) Lawmakers have introduced a bill that would ban health insurers from owning or controlling physician practices and outpatient providers, a direct strike at the vertically integrated models dominating Medicare Advantage. 🔎 Why it matters: Even though the bill targets Medicare/MA, it signals growing federal pressure against insurer-provider consolidation. If these structures unwind, it could reshape pricing, access, and leverage across the entire healthcare ecosystem, commercial plans included. 💡 Takeaway for employers & advisors: This is another reminder that the system’s incentives are misaligned. Whether or not the POP Act passes, momentum is building toward transparency, accountability, and separating financial motives from patient care. Now is the time for employers to rethink how their plans are built and to lean into models that prioritize outcomes, not ownership. A link to the article is in the comments. #HealthcarePolicy #HealthReform #PatientsOverProfits #HealthcareTransparency #HealthInsuranceReform #MedicareAdvantage

When health systems and insurers clash, patients often pay the price. I recently spoke with CBS News Minnesota about the growing tension between M Health Fairview and UnitedHealthcare, a dispute that could push thousands of Minnesotans out of network. This isn’t just a contract issue, it’s a symptom of a larger challenge in U.S. healthcare: balancing fair reimbursement, provider sustainability, and patient access. You can watch the full story here: 🔗 https://lnkd.in/gXUdV5BD #HealthcareLaw #MinnesotaHealthcare #HoltLaw #HealthPolicy #PatientAccess

Attention California medical and home health care providers: A recent The New York Times investigation highlights significant challenges in Medicare billing and systemic risks affecting healthcare providers nationwide. Staying informed is crucial for compliance and protecting patients’ benefits. Read the full investigation here: https://nyti.ms/3LxVFEA #HealthcareCompliance #Medicare #HomeHealthCare #CaliforniaHealthcare

The Centers for Medicare & Medicaid Services (CMS) has finalized critical updates to the Medicare Physician Fee Schedule (PFS), set to take effect in January 2026. These changes aim to improve payment accuracy, strengthen primary care, and reduce wasteful spending — marking meaningful progress toward a more efficient and equitable health care system. Read the statement from Mark E. Miller, PhD, executive vice president of Health Care at Arnold Ventures: https://lnkd.in/gfXtMbDN

Big win for primary care! CMS just finalized long-overdue reforms to improve payment accuracy and better support the backbone of our health system. Excited to see this momentum toward smarter, more accurate Medicare payment for clinicians. Check out AV's full statement ⬇️

Primary care in America is at a crossroads. Traditional fee-for-service models in primary care have led to rushed appointments, heavy administrative burden, and frustrated patients who struggle to access their own doctors. There's a better way: Direct Primary Care (DPC). DPC is a membership-based healthcare model where patients pay a transparent monthly membership fee directly to their primary care clinician. In return, they get: ▫️ Unlimited visits with no copays ▫️ Same-day or next-day appointments ▫️ 30–60 minute appointment times ▫️ Direct access to their doctor via phone/text ▫️ Transparent, upfront pricing Unlike traditional primary care, DPC clinicians operate independently and focus solely on their patients' best interests—not the competing priorities of insurance companies or hospital systems. This independence allows them to maintain smaller patient panels and spend meaningful time with each person, building lasting relationships and focusing entirely on what matters most: their patients' health outcomes. For employers, DPC represents a way to provide high-quality primary care while reducing overall healthcare costs through better prevention and chronic disease management. Over the next several weeks, we'll explore how DPC is transforming healthcare for members, clinicians, and employers. What questions do you have about Direct Primary Care? Drop them in the comments! #DirectPrimaryCare #PrimaryCare #EmployerHealthcare #HealthcareInnovation