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CMS Issues CY 2026 Physician Fee Schedule Proposed Rule
CMS July 14 issued a proposed rule that would update physician fee schedule (PFS) payments for calendar year (CY) 2026.
Keeping the Brakes on Physician-owned Hospitals is Best for Patients
Fair competition has always been the driving principle of our nation’s economy. This includes health care, and it’s the reason the Ethics in Patient Referrals Act, more commonly known as the “Stark Law,” has been on the books for decades to protect the Medicare program from the inherent conflict of interest created when physicians self-refer their patients to facilities and services in which they have a financial stake.
Fact Sheet: Physician Self-referral to Physician-owned Hospitals
Some members of Congress continue to propose weakening Medicare’s prohibition on physician self-referral to new physician-owned hospitals and loosening restrictions on the growth of grandfathered hospitals. The Patient Access to Higher Quality Health Care Act of 2023 (H.R. 977/S.470), would allow problematic physician-owned hospitals to open and permit unfettered growth in existing physician-owned hospitals.
New Analysis Validates Need to Preserve Restrictions on the Growth of Physician-owned Hospitals
As some members of Congress continue to propose weakening Medicare’s prohibition on physician self-referral to new physician-owned hospitals (POHs) and loosening restrictions on the growth of existing POHs, new data from Dobson | DaVanzo show that POHs report fewer quality measures and perform worse on readmission penalties compared to full-service community hospitals.
Special Bulletin: CMS Issues Physician Fee Schedule Final Rule for CY 2025
The Centers for Medicare & Medicaid Services (CMS) Nov. 1 issued a final rule that will update physician fee schedule (PFS) payments for calendar year (CY) 2025. The rule also includes policies related to the Medicare Shared Savings Program (MSSP) and the Quality Payment Program (QPP), both of which were created by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
Analysis of Selected Medicare Quality Measure Reporting Data by Hospital Ownership
Dobson | DaVanzo recently examined Medicare claims data comparing demographic and clinical characteristics of facilities and patients receiving care at physician-owned hospitals (POHs) and all other acute care hospitals (non-POHs). That report showed that relative to POHs, non-POHs care for older, more medically complex patients who are on average burdened with multiple co-morbid conditions, while also operating on lower margins and providing more uncompensated and unreimbursed care.
The key to new payment programs? Data management.
Value-based payment approaches, including Medicare’s Quality Payment Program for physicians and other eligible clinicians, tie fees and bonuses to how well providers perform on various qualit
The Ins and Outs of Physician Payment After Medicare Sustainable Growth Rate Reform
On April 16, President Barack Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015
MIPS Quality Measurement: Implications for Hospitals and Clinician Partners
However, the QPP’s payment implications will vary depending on a number of scenarios – such as whether a clinician is attributed to the Merit-Based Incentive Payment System (MIPS)i; to a