CMS’ Plan To Recoup Billions In Outpatient Payments Delayed Until ’27
The clawback originally was set to go into effect in 2026. However, Stat says, Medicare will move forward with surveys that will pinpoint how much drugs cost for hospitals — surveys that hospitals have managed to push off for 20 years.
Stat:
Medicare Backs Off Plan For Quicker Clawback Of $7.8 Billion From Hospitals
Hospitals scored a win in Medicare’s final outpatient payment rule for 2026, as they persuaded federal Medicare officials to back off a plan that would have clawed back $7.8 billion a decade sooner than originally planned. (Herman, 11/24)
Modern Healthcare:
Medicare Advantage Audit Ruling Appealed By CMS
The Centers for Medicare and Medicaid Services has reignited the fight over how the government can audit Medicare Advantage companies. CMS on Friday appealed to the Fifth Circuit Court of Appeals a federal court’s decision to vacate the 2023 Medicare Advantage Risk Adjustment Data Validation regulation. Under the rule, CMS eliminated a statistical tool known as the fee-for-service adjuster. The adjuster was used to compare Medicare Advantage insurance companies’ errors to those in traditional Medicare. (Tepper, 11/24)
Modern Healthcare:
Cardiac Ablations Added To ASC-Covered Procedures List
The Centers for Medicare and Medicaid Services added cardiac ablation procedures to its list of procedures covered in ambulatory surgery centers. The change is outlined in the agency’s 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule, which will take effect Jan. 1. The agency added 547 procedures to the list, many of which were cardiac ablation procedures. Among them are catheter procedures to destroy abnormal heart signals and block faulty heart signals at the heart’s electrical hub. (Dubinsky, 11/24)
More news from the health care industry —
CalMatters:
California Found Red Flags In Nursing Homes But Licensed Them Anyway.
New lawsuits against California nursing home owner Shlomo Rechnitz include allegations against facilities that received state licenses after a years-long impasse. (Wiener, 11/24)
Chicago Tribune:
Hospitals Funnel Patients Into Long-Lasting Guardianships
As Gary Ellis lay dying in August 2023, no one at the facility caring for him called his son. Instead, staffers called Ellis’ court-appointed state guardian, who had recently taken charge of all decisions related to the 69-year-old man’s care. Not until it was too late did Gary Brown learn his father had been at death’s door, Brown told the Tribune. (Hoerner, Gutowski and Schencker, 11/23)
KFF Health News:
More People Are Caring For Dying Loved Ones At Home. A New Orleans Nonprofit Is Showing Them How
Liz Dunnebacke isn’t dying, but for a recent end-of-life care workshop in New Orleans, she pretended to be. Dunnebacke lay still atop a folding table that was dressed as a bed, complaining that her legs hurt. Registered nurse Ana Kanellos, rolling up two small white towels, demonstrated how to elevate her ankles to ease the pain. “ Mom’s legs are always swollen? Raise ’em up,” Kanellos said. About 20 New Orleans residents listened intently, eager to learn more about how to care for loved ones at home when they’re nearing the end of their lives. (Parker, 11/25)
The Colorado Sun:
Denver Metro Hospitals Made $1.3 Billion In Profits In 2024, But Little Of That Came From Treating Patients
The 28 hospitals in the seven-county Denver metro area made roughly $53 million in profit in 2024 from patient care. But other sources of income — which, depending on the hospital, may include investments, tax dollars, donations, and income from a federal prescription drug program — brought in more than $1.5 billion for the hospitals, helping offset additional expenses and delivering the heftier profit number. (Ingold, 11/24)
Newsweek:
Nurses Union Says Trump Policy Will Worsen Crisis-Level Conditions
The Massachusetts Nurses Association (MNA), the largest union of registered nurses in the Commonwealth, said the Trump administration’s decision to snub the nursing profession will deepen the national health care crisis. Following direction from the Trump administration’s One Big Beautiful Bill, the Department of Education determined that nursing was among the programs that would now be excluded from the “professional degree” list. This would affect how those seeking a nursing degree would be reimbursed for student loan payments. (Giella, 11/24)
