Reimbursement
Primary care physicians see an average pay increase of only 1.4%, while specialists experience an even smaller increase of 1%.
CMS proposes to remove four SDOH standardized patient assessment data elements to reduce burden.
CMS also proposes to update the outlier threshold so that estimated outlier payments remain at 2% of total payments.
This translates to an estimated increase of $695 million in payments from fiscal year 2025, CMS says.
The American Hospital Association voiced concern over that rate and a 2.6% increase for long-term care hospitals.
Adjustments are estimated to total $196.5 million in 2026, CMS says.
Declining physician payments and rising operational costs place emergency medicine at financial risk, RAND finds.
This translates to $25 billion for MA insurers in 2026.
CMS declined to cover obesity drugs, as proposed under the Biden administration.
Cuts in Medicaid would likely mean that many beneficiaries would lose coverage, leading to more uncompensated care for hospitals.