Reimbursement
The company pulled in $6.29 billion in profit during Q1, but was hit by Medicare Advantage expenses.
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.