CMS finalizes reforms to support primary care

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

With open enrollment season here and healthcare costs rapidly rising, creating more efficient, competitive healthcare markets has never been more critical. The Center recently submitted comments to Centers for Medicare & Medicaid Services on the Medicare Physician Fee Schedule (PFS) and the Hospital Outpatient Prospective Payment System (OPPS) proposed rules. In our comments, we recommended that Medicare digital health reimbursements be based on clinical value rather than equipment costs or physician time, drawing on Peterson Health Technology Institute (PHTI)'s assessments of remote monitoring and virtual mental health solutions. The comments also emphasized the need for stronger hospital price transparency standards to help employers and consumers compare prices, and site-neutral payment policies in Medicare to limit incentives for market consolidation that drive up healthcare spending. Read more on: OPPS Comment: https://lnkd.in/ebdn2YJm PFS Comment: https://lnkd.in/eEwXV-AU

Delays in prior authorizations for Medicare Advantage patients are impacting access to post-acute care across the nation. Challenges are also causing financial strain for post-acute care providers. In a recent Modern Healthcare article, Compassus Senior Vice President of Value-Based Care Jordan Holland shared how Compassus is partnering with health systems to help patients receive timely care and ensure providers are paid fairly. Read more at https://bit.ly/3LcmjTf. #Compassus #ModernHealthcare #HealthCareLeadership

Home health serves as a lifeline in communities across the country, and Centers for Medicare & Medicaid Services is getting ready to make a costly mistake. Steve Landers MD, MPH, CEO for the Alliance, recently wrote an op-ed in Chief Healthcare Executive emphasizing that if CMS follows through with its plan to cut 9% of home health funding in 2026, patients will suffer.  Learn more: https://lnkd.in/ecBWqGRp 

The CMS proposed 9% cut to home health funding will reduce access to care for millions of homebound adults, resulting in worse health outcomes. It will also place more care responsibilities on the shoulders of over-stretched family caregivers. And it will result in higher costs for Medicare, due to increased reliance on expensive institutional care. In short, everyone loses. We're grateful for the ceaseless advocacy from National Alliance for Care at Home and their CEO, Steve Landers MD, MPH, as they push back on ill-conceived funding cut.

New Course: Engaging the Board in Quality and Value Based Care In today’s health care environment, value-based care and payment continue to gain momentum and traction because value-based care improves clinical quality, satisfies patients and families, advances community health, and lowers per capita costs. Payors such as Medicare, Medicaid, and commercial insurers are increasingly utilizing value-based payment methods, such as shared savings and bundled payments, in their contracting with health care organizations. As a result, it is essential for rural health care organizations (HCOs) to understand value-based care (VBC). Each hospital will complete a Value-Based Care Strategic Planning Tool which will assess your health care organization's (HCO) capacities (leadership, resources, processes, infrastructure, etc.) to deliver value-based care (VBC). Enroll now: https://lnkd.in/epH5G48G

President Trump and Congress created the new Rural Health Transformation Program in July, partly as a way to ensure passage of a tax package that would result in significant cuts to Medicaid programs. Healthcare leaders said the Medicaid cuts would be devastating to hospitals and health systems, and especially harmful to rural hospitals. Hospital associations are anxious to see how much aid will actually go to rural hospitals, which are extremely vulnerable. Rural hospitals have struggled financially for years, and healthcare leaders have said the reductions in Medicaid funding could force some rural hospitals to scale back services or shut their doors for good. Learn more at Chief Healthcare Executive: https://lnkd.in/e4_Xh9Gr

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

I’m proud to see my colleagues, Anil Shankar and Jennifer Walsh, featured in a recent health care innovation article sharing the impacts of the new federal budget law H.R. 1 on Medicaid and the challenges ahead for providers and states. If you’re involved in health care or Medicaid policy, I encourage you to read more as they break down what these changes mean for the future of Medicaid and health care providers: https://lnkd.in/gBEckrSQ

As the federal government shutdown enters its fourth week, various health programs such as hospital-at-home services, telehealth and ambulance services, and open enrollment are either seeing direct impacts or are facing the potential for disruptions. The federal government entered a partial shutdown on October 1 after Congress failed to pass a continuing resolution (CR) to fund agencies into the new fiscal year. The deadlock centers on health care policy — specifically whether to extend enhanced Affordable Care Act (ACA) premium tax credits that are set to expire at the end of the year. Democrats are demanding the subsidies be renewed as part of any funding package, while Republicans argue the issue should be debated separately. The Senate has rejected the House-passed CR multiple times, and the stalemate has now entered its fourth week. Although essential services and mandatory programs such as Medicare, Medicaid, and Veterans Health continue to operate, a growing number of federal health care functions are being curtailed or delayed. For hospital and other health care entities, Bruce Thompson II and Ken Preede provide a review of impacts of the shutdown so far and an outlook going forward should the shutdown continue. https://lnkd.in/eizXYP_r