joe, Author at DeBrunner & Associates

CMS Will Continue Rolling Out Mandatory Models

The Centers for Medicare & Medicaid Services and its Center for Medicare and Medicaid Innovation intend to continue developing and introducing mandatory Medicare models with an emphasis on driving more value-based care. That is the message delivered by CMS administrator Mehmet Oz and CMMI director Abe Sutton during a recent conference. While the track record of CMMI’s models – both voluntary and mandatory – is not great, policymakers believe they remain the best way for government to continue encouraging health care providers to focus more on the delivery of value-based care. To date, only four of the agency’s approximately 50 [...]

joe2026-03-05T17:04:15-05:00March 10, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare|

New Group Targets Hospitals

Insurance interests have joined forces to create a new group that is targeting hospitals and blaming them for rising health care costs. The group, called “Hospital Watch,” was formed last month and describes itself as … a watchdog group dedicated to shining a light on corporate hospitals as the top culprit in driving up U.S. healthcare costs – exposing corporate hospitals’ monopolistic practices in price gouging patients with excessive markups and hidden fees with no transparency while forcing patients and employers to pay more for their care. Hospital Watch is the creation of another group, called “Better Solutions for Healthcare,” [...]

joe2026-03-05T14:39:59-05:00March 9, 2026|hospitals|

Rural Health Transformation Plans Face Pushback

In states across the country, legislators, hospital and health care groups, and others are objecting to the plans their state governments submitted to the federal government for how they would like to spend Rural Health Transformation funds – plans that federal regulators have already approved. In Colorado, Michigan, North Dakota, Nebraska, and Wyoming, legislators have even threatened to withhold the enabling legislation needed to spend the federal money. One of their primary objections is that the approved Rural Health Transformation program plans, consistent with federal guidelines, focus on innovation in the delivery of rural health care and do not help [...]

joe2026-03-04T12:23:38-05:00March 5, 2026|Congress, hospitals|

States, Hospitals, Patients Brace for Big Beautiful Bill Effects

The effects of last year’s One Big Beautiful Bill Act will soon be felt by states, providers, and consumers and some of them are already preparing for the impact. States face an expected loss of $664 billion in Medicaid money over the next eight years as a result of 12 provisions in the 2025 law. The major causes: Medicaid work requirements that will reduce eligibility, more frequent eligibility redeterminations, and tougher limits on revenue-generating Medicaid provider taxes and Medicaid managed care state-directed payments. Some states will lose more than others. The biggest losers, by percentage, will be Arizona, Iowa, and [...]

joe2026-03-03T16:52:49-05:00March 4, 2026|hospitals, Medicaid, Medicaid managed care, Medicaid regulations|

MedPAC Posts Agenda for March 2-3 Meeting

The Medicare Payment Advisory Commission has posted the agenda for its next public meeting, which will be held on Monday, March 2 and Tuesday, March 3. The subjects scheduled for consideration during MedPAC’s next two-day session are: mandated report: Assessment of the Medicare ground ambulance data collection system access to hospice and certain complex palliative services for beneficiaries with end-stage renal disease and beneficiaries with cancer provider participation in Medicare Advantage networks considerations for implementing Medicare Advantage encounter data in risk adjustment the complexity of Medicare enrollment decisions for beneficiaries Medicare Part B premium payment basics Go here to see [...]

joe2026-02-26T16:20:05-05:00February 27, 2026|Medicare, Medicare reimbursement policy|

Federal Health Policy Update for February 26

The following is the latest health policy news from the federal government for February 20-26. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress are in session this week and next. The partial shutdown of the Department of Homeland Security that began on February 23 continues. The House Ways and Means Committee held a hearing titled “Advancing the Next Generation of America’s Health Care Workforce” to examine the shortage of resident physicians and explore ways to strengthen rural health care providers and Graduate Medical Education (GME). Watch the hearing and review the witness testimony here. Centers for Medicare & [...]

joe2026-02-26T15:43:01-05:00February 26, 2026|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Groups Protest No Surprises Act Implementation

A group of more than 60 health care payers, employer groups, and others have written to the departments of Health and Human Services, Labor, and the Treasury to protest how the Independent Dispute Resolution process created under the No Surprises Act is deciding pay disputes between providers and insurers. The letter accuses payers of using the Independent Dispute Resolution process as a money-making tool. It also maintains that the panels deciding the disputes are favoring providers – which are winning 85 percent of the cases they consider – and are operating without sufficient guidance from federal regulators. It also notes [...]

joe2026-02-25T13:05:12-05:00February 26, 2026|Uncategorized|

PRICE TRANSPARENCY NOT LIVING UP TO OBJECTIVE – YET

The requirement that hospitals post transparent information about their prices is not yet leading consumers to do more price shopping before obtaining care. Instead, to the degree that hospitals are fulfilling the requirement at all, the data they share is mostly used by other hospitals and insurers to aid in their negotiations with one another. Even when hospitals post the required data – many still do not – that data often is not presented in a way that is useful, or even comprehensible, for consumers. In addition, it can be difficult for consumers to make apples-to-apples comparisons between providers because [...]

joe2026-02-25T08:05:53-05:00February 25, 2026|hospitals|

Medicare Advantage Musical Chairs Continues

Even as the number of seniors enrolling in Medicare Advantage plans rises every year, the program’s stability is threatened by the withdrawal of those plans from the program. According to a new JAMA Network analysis, after years of just one percent of Medicare Advantage participants being forced to find new plans because their plan left the program, the rate of participants who need to find new plans for that reason rose to 6.5 percent in 2025 and to ten percent in 2026. This is occurring, moreover, even though the number of plans participating in Medicare Advantage continues to increase. The [...]

joe2026-02-24T14:21:56-05:00February 24, 2026|Medicare|

Rate of Timely Prenatal Care Declines

The rate at which pregnant women start receiving prenatal care during their first trimester declined between 2021 and 2024, as did the rate of pregnant women who received late or no care. Meanwhile, the rate at which pregnant women initiated prenatal care during their second trimester rate rose. These figures come from a new data brief from the Centers for Disease Control and Prevention’s National Center for Health Statistics. Highlights from the CDC’s findings, taken directly from the report, include: After increasing from 2016 (77.1%) to 2021 (78.3%), prenatal care beginning in the first trimester decreased to 75.5% in 2024. [...]

joe2026-02-19T16:28:49-05:00February 23, 2026|Uncategorized|

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