CMS final rule for CY 2025: Key updates impacting Medicare payments, quality programs
Editor's Note The Centers for Medicare & Medicaid Services (CMS) issued its final rule for the 2025 calendar year, updating payment systems and quality reporting requirements across healthcare settings, JD Supra November 19 reports. Effective January 1, 2025, the rule outlines significant changes to Medicare payments and conditions for participation…
Analysis: Overuse of back surgeries costs Medicare $2 billion, risks patient safety
Editor's Note More than 200,000 unnecessary back surgeries were performed on older adults from 2019 to 2021, costing Medicare approximately $2 billion and exposing patients to avoidable risks, according to a November 14 analysis from the Lown Institute. The evaluation focused on spinal fusion, laminectomy, and vertebroplasty procedures, which are…
AHA's Congressional "wish list" calls for financial relief, patient access, workforce protections
Editor's Note In a November 12 letter to Congress, the American Hospital Association (AHA) outlined its priorities for the lame-duck legislative session, focusing on measures to stabilize hospitals and health systems facing significant financial and operational pressures. If enacted, these recommendations would support the nation’s healthcare infrastructure amid rising…
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…
2025 Medicare reimbursement cuts spark concern among physicians
Editor's Note Doctors facing inflationary and operational cost increases are decrying recently finalized 2025 Medicare reimbursement rates, according to a November 4 report in Healthcare Dive. The 2025 rates reduce physician payments by 2.9% while increasing rates for hospital outpatient departments and ambulatory surgery centers (ASCs) by 2.9%, the outlet…
Trump vs. Harris: Key differences in healthcare proposals for Medicaid, Medicare, private insurance, abortion
Editor's Note When it comes to the 2024 presidential election, “Neither candidate addresses a return to the fundamental tenet of healthcare: the patient-physician relationship,” reads the closing line of an “election guide” from Richard Menger MD MPA. In the preceding paragraph, Menger also argues that both candidates also neglect issues…
Medicare Advantage insurers prioritize profits over patients, Senate reports
Editor's Note A Senate report reveals that Medicare Advantage insurers are increasingly prioritizing profits over patient care by ramping up the use of prior authorization to deny necessary services, particularly post-acute care, for older adults, Becker’s Hospital Review reported October 17. In May 2023, the Senate Permanent Subcommittee on Investigations…
Outpatient, ASC clinicians share perspectives on upcoming NOPAIN Act implementation
Editor's Note On October 14, Anesthesiology News published a monograph featuring clinical perspectives on how “those working in the trenches of postsurgical pain management” are preparing for the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, which outlines new, separate Medicare reimbursement for certain non-opioid analgesics in outpatient and ambulatory…
Medicare policy on prior authorization falls short on shifting outpatient surgery trends
Editor's Note A Medicare policy introduced in 2020, which requires prior authorization for certain procedures done at hospital outpatient departments (HOPDs), has not significantly reduced the volume of surgical procedures being done at these facilities, reports a study by Michigan Medicine, University of Michigan, published on October 9. The policy,…
CMS proposes $2 Drug List Model to reduce out-of-pocket costs for Medicare recipients
Editor's Note CMS has taken the next steps in making prescription drugs more affordable for Medicare recipients, according to an October 9 report from The US Department of Health and Human Services (HHS). The proposed Medicare $2 Drug List Model, developed in line with President Biden’s Executive Order 14087, aims…
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