HHS restructures for the DOGE era
A massive HHS restructuring announced March 27 could have an indirect impact on providers. Secretary Robert F. Kennedy Jr. announced HHS would reduce its workforce by 10,000 FTEs, part of a 25% downsizing from 82,000 to 62,000, with previously announced early retirements and buyouts also factoring into the count. The department’s agencies will be pared…
Hospitals’ Medicaid appeal options may be more limited after court ruling
A recent appeals-court ruling restricts options for hospitals seeking to use litigation to ensure prompt Medicaid payment. The March 14 ruling by the U.S. Court of Appeals for the Seventh Circuit in Saint Anthony Hospital v. Whitehorn essentially states that hospitals do not have a legal right to sue state Medicaid programs under federal law…
Hospital financial metrics suggest need for added Medicare payment, MedPAC says
Hospital metrics suggest FY26 Medicare payment should increase by more than what’s provided in the statutory formula, according to a formal recommendation by the Medicare Payment and Advisory Commission (MedPAC). Beneficiary access to care appeared to be strong in 2023, the latest year for which data was available, but quality indicators were mixed, according to…
4 strategies to reduce ED overcrowding
Recent studies are quantifying what news reports tell us: Americans are waiting longer than ever to get seen and treated in the ED. Several factors contribute to this trend: patient volumes are increasing while ED and inpatient bed capacity decline; individuals without a regular primary care provider often turn to the ED as their first…
Trump administration keeps up the fight on 340B, Inflation Reduction Act concerns
The issue of drug pricing is proving to be an area of harmony and continuity between the Trump and Biden administrations, at least for now. In recent days, the Trump administration moved to defend the Biden administration’s stance in opposition to drug manufacturers that are looking to offer 340B Drug Pricing Program discounts through a…
Trump administration charts a new course at the Center for Medicare & Medicaid Innovation
The Trump administration has started to streamline the portfolio of alternative payment models sponsored by the Center for Medicare & Medicaid Innovation (CMMI), recently announcing the early expiration of four models. CMS said the decision resulted from an assessment of whether the models could meet statutory criteria to be expanded into the full Medicare program.…
Dr. Oz describes changes he would bring to Medicare, Medicaid as CMS administrator
April 3 update: The Senate formally confirmed Oz as CMS administrator via a 53-45 party-line vote. He is expected to be sworn in and begin work within days. March 25 update: The Senate Finance Committee voted 14-13 along party lines to send Oz’s nomination to the full Senate for a formal confirmation vote. Democrats voting…
Affordable Care Act marketplace enrollment likely to decrease under proposed regulations
The Trump administration’s first regulations on the Affordable Care Act health insurance marketplaces are projected to reduce enrollment. As announced by CMS on March 10, a soon-to-be-published proposed rule would implement new program integrity standards for the marketplaces. Part of the motivation stated in the rule is to address “a substantial risk of improper enrollment.”…
Medicaid DSH payment cut again delayed in proposed federal funding bill (updated)
March 15 update: The bill has passed both chambers of Congress as originally drafted and described below. Hospitals that receive Medicaid disproportionate share hospital (DSH) payments would get continued relief from a pending big cut, according to the latest proposed FY25 continuing resolution (CR). A scheduled three-year, $24 billion reduction would be delayed through September…
Injunction granted on policy change that would hamper funding for teaching hospitals
A federal judge has extended a block on a Trump administration policy that would cap reimbursement for indirect medical research costs at institutions such as teaching hospitals. Per the Feb. 7 policy issued by the National Institutes of Health (NIH), add-on payments for facility and administrative expenses as part of research grants would be limited…