New Rating Rules May Give Medicare Advantage Insurers A $13B Boost
One proposed change to the star rating system is bringing back the “reward factor.” This provision, previously used until 2023, would increase payments to insurers that perform well. As a result, Medicare is scrapping the “health equity index” that was set to go into effect in 2027.
Medicare Advantage insurers scored a Thanksgiving gift, as President Trump’s Medicare agency added back a bonus system that rewards health plans with consistently high marks. (Herman, 11/28)
A new Medicare policy on complex surgical procedures could drive a deluge of patients to outpatient facilities. But while some view the change as a win for beneficiaries and taxpayers, others see clinical risks. The Centers for Medicare and Medicaid Services will phase out the Medicare Inpatient-Only List over the next three years under the Hospital Outpatient Prospective Payment System final rule for 2026, which it published Friday. (Early, 11/26)
In news about rural health care —
North Carolina is seeking $1 billion from the federal government for a wide-ranging plan that could reshape rural health care across the state. (Baxley, 12/1)
Rural hospitals nationwide have been evaluating the future since the One Big, Beautiful Bill became law in July. Changes to Medicaid that will impact their revenue have led some medical facilities to cancel planned programs or projects, seeking savings before the changes take effect in 2027. Garrett Regional Medical Center is doing the opposite, hoping to expand its services despite the current health care landscape uncertainty. (Mause, 11/30)
As the final hues of autumn linger in the Blue Ridge Mountains, the 200-person community of Churchville, Virginia, is grappling with the loss of its health clinic. Gone are the days of seniors walking down the road from their house to see the town doctor. (McKend, 11/30)
More health care industry developments —
As the first anniversary of UnitedHealthcare CEO Brian Thompson’s killing looms this week, the man charged in his death will be in court fighting to prevent prosecutors from using evidence they say links him to the crime. Luigi Mangione, 27, is set for hearings starting Monday on his bid to block the Manhattan District Attorney’s Office from showing or telling jurors about items seized during his arrest at a yet-unscheduled state murder trial. (Sisak, 12/1)
Advocate Health CEO Gene Woods’ compensation surged to $25.8 million in 2024, a 49 percent jump from the $17.3 million he earned the previous year, according to a recent tax filing. (Crouch, 11/28)
Jennifer Capasso had endured multiple tumors. She wondered what might be said during her next cancer surgery. So, she hit record on her phone. (Goldstein, 12/1)
