Insights: Healthcare

Medicare Outpatient/ASC Reimbursement

CMS has issued the CY26 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule. Under the rule, CMS proposes to increase OPPS and ASC payments by an aggregate 2.4% for CY26 relative to CY25 ($b and $480m increases, respectively). That rate update is comprised of 3.2% market basket update reduced by a...

Medicare Physician Fee Schedule (PFS) Reimbursement

CMS has issued the proposed CY26 physician fee schedule (PFS) rule. Under the rule, CMS proposes implementing two separate conversion factors (CFs). For Alternative Payment Model (APM) participants, the aggregate CF is set at $33.59, a 3.83% increase ($1.24) from the CY25 CF of $32.35. For non-qualifying participants (non-QPs), the aggregate...

Financials, Healthcare, Macro, Tech / Media / Telecom

Reconciliation and Recissions

Speaker Johnson (R-LA), House Budget Committee Chair Arrington (R-TX), and Senate Finance Committee Chair Crapo (R-ID) have all confirmed their intent to enact another two reconciliation bills prior to the next election, with the first coming this fall. As I previously noted, Speaker Johnson, Rep. Roy (R-TX), and Sen. Johnson (R-WI) had already...

Medicare FFS Prior Authorization (WISeR Model)

The CMS Innovation Center (CMMI) has announced the Trump administration’s first new model, known as the Wasteful & Inappropriate Service Reduction (WISeR) Model. At a high-level, the model will test the expansion of prior authorization (PA) requirements in traditional fee-for-service (FFS) Medicare and the involvement of private sector tech...

Medicare DME Competitive Bidding (CBP)

The Trump administration continues to signal that a new round of the Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program (CBP) is in the offing. Earlier this year, a proposed rule aimed at improving the “fiscal sustainability of the CBP” appeared on the HHS unified agenda (release tentatively...

Medicare FFS Reimbursement (Home Health)

CMS has issued the CY26 Home Health Agency (HHA) proposed rule. Under the rule, CMS proposes decrease payments by -6.4% (-$1.135b) for CY26 relative to CY25. Comprising that net update is a 2.4% market basket update, a -0.5% outlier payment decrease, and an aggregate -3.7% prospective behavioral adjustment due to the continued implementation of...