Physician Groups Express Concern Over Efficiency Adjustment and New ASM Model, and Push Towards a Value-Based Model On October 31, 2025, the Centers for Medicare & Medicaid Services released its finalized Medicare Physician Fee Schedule for calendar year 2026. This article discusses the provisions contained in the MPFS final rule, as well as stakeholder reactions. On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) released its finalized Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2026, which “advances primary care management through improved quality measures, reduces waste and unnecessary use of skin substitutes, and introduces a…
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Financial Implications to Hospitals Serving Substantial Percentage of Medicaid & Medicare Patients On November 21, 2025, the Centers for Medicare & Medicaid Services released its Calendar Year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule, affecting approximately 4,000 hospitals and 6,000 ASCs. The rule finalizes payment updates, policy reforms, and transparency requirements that will impact hospital and ASC operations beginning January 1, 2026. This article discusses the key OPPS changes and updates included in the Final Rule. On November 21, 2025, the Centers for Medicare & Medicaid Services (CMS) released its Calendar Year (CY)…
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Valuation Implications The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on reimbursement to healthcare providers. The 2025 proposed fee changes are significant. This article focuses on the proposed fee changes and how these changes may affect valuations of healthcare practices. The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on reimbursement to healthcare providers. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter and being used as…
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Patchwork Approach Continues in Congress On March 9, 2024, President Biden signed into law a $460 billion spending package to continue funding the federal government for the remainder of the 2024 fiscal year. Contained within the spending package was legislation to cut in half the 2024 Medicare physician payment update of approximately -3.4%. This article discusses the payment update, other healthcare provisions contained in the bipartisan spending bills, and responses from stakeholders. On March 9, 2024, President Biden signed into law a $460 billion spending package to continue funding the federal government for the remainder of the 2024 fiscal year.[1]…
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Stakeholders Welcome and Also Dispute Various Changes On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2024. In addition to the agency’s suggested cut to physician payments, the proposed rule announced changes in policies for the advancement of health equity, as well as the expansion of access to critical behavioral health and oral health services. This article discusses the proposed changes. On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY)…
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Center for Medicare & Medicaid Publishes Proposed and Final Rules on Medical Reimbursement Rates The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on physician reimbursement. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter and being used as a benchmark for private reimbursement rates. Consequently, changes to Medicare and Medicaid payment rates are notable as they may indicate a shift in the greater healthcare reimbursement landscape. Over the summer, the Centers for Medicare & Medicaid Services (CMS) released…
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Regulatory Issues (Part IV of V) As discussed in the first installment of this five-part series, rural health clinics (RHCs) are statutorily-created entities, established via the Rural Health Clinic Service Act of 1977. These providers face a range of federal and state legal and regulatory constraints, which affect their formation, operation, and transactions. This installment will discuss two important regulatory issues affecting RHCs: licensure requirements, and fraud and abuse law compliance. As discussed in the first installment of this five-part series, rural health clinics (RHCs) are statutorily-created entities, established via the Rural Health Clinic Service Act of 1977.[i] These providers…
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In an Era of Reform: Value Drivers (Part II of II) As stated in Part I of this II-part series, as the demand for healthcare services continues to grow, the site at which these services are performed is experiencing a simultaneous transformation from the inpatient (e.g., hospital) setting to the outpatient setting—e.g., at ambulatory surgery centers (ASCs). This article will review the unique value drivers that impact the typical valuation approaches, methods, and techniques that are often utilized in determining the value of ASCs in the current healthcare delivery system. Introduction As stated in Part 1 of this two-part series,…