What's Happening?
The American Hospital Association (AHA) has expressed concern over recent updates by the Centers for Medicare and Medicaid Services (CMS) regarding hospital price transparency regulations. CMS has revised
Medicare payment policies and rates for hospital outpatient and Ambulatory Surgical Center services for 2026, including a 2.6% increase in outpatient payment rates for hospitals meeting quality reporting requirements. The AHA argues that these changes exacerbate financial pressures on hospitals, particularly those serving vulnerable communities. CMS aims to improve care quality and reduce spending, but the AHA warns of potential negative impacts on hospital operations.
Why It's Important?
The CMS updates are significant as they affect approximately 4,000 hospitals and 6,000 ASCs, with potential savings of $11 billion over the next decade. While CMS believes these changes will enhance care access and transparency, the AHA is concerned about the financial burden on hospitals, especially those in rural or low-income areas. The updates could lead to reduced funding for essential services, impacting patient care and hospital sustainability. The debate highlights the ongoing tension between regulatory efforts to control healthcare costs and the operational realities faced by healthcare providers.
What's Next?
CMS plans to phase out the Inpatient Only List over the next three years, allowing more procedures to be performed on an outpatient basis. This policy aims to provide beneficiaries with more choices and potentially lower out-of-pocket expenses. However, the AHA opposes this move, citing concerns about the impact on hospital outpatient departments. CMS will also maintain its 340B recoupment policy, with planned reductions in hospital payments starting in 2026. The AHA continues to advocate for adjustments to these policies, emphasizing the need to protect hospitals serving vulnerable populations.
