In Depth Analysis

The CPT® Editorial Panel will meet in New Orleans, Louisiana, from September 21 to 23, 2023. Read on for an overview of CPT, why it matters to the world of health policy and what to expect from the meeting.

In the 118th Congress, several key committees have advanced legislation that would increase PBM transparency and reporting obligations and modify other business practices. Read on for a side-by-side comparison of House and Senate PBM bills and our forecast of the possible effects of these proposed changes to PBM operations.

Read our full analysis of the final rule that updates Medicare payment policies and quality reporting programs for inpatient hospital services, and builds on key agency priorities, including advancing health equity and improving the safety and quality of care.

On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-1784-P] Proposed Rule, which includes proposals related to Medicare physician payment and the Quality Payment Program (QPP). Physicians and other clinicians are once again facing large, proposed cuts of more than 3.36% for CY 2024. While Congress has provided temporary partial fixes to physician payment in the last several years, its latest fix in the Consolidated Appropriations Act, 2023 (CAA, 2023), enacted at the end of 2022, does not offset all the proposed cuts in this rule. In all, the budget neutrality constraints of the fee schedule continue to result in a negative proposed conversion factor (CF) update. Beyond the cut to the CF, CMS proposes significant policies related to telehealth services, updates to the Medicare Shared Savings Program (MSSP), initiatives promoting health equity and other changes to further develop physician quality initiatives.

On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1786-P], which includes proposals to update payment rates and regulations affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings beginning in CY 2024.