New estimates from DataGen highlight $1.9B in physician payment increases — and a looming $98B Medicare cut  The One Big Beautiful Bill Act (OBBBA) — a major budget reconciliation bill passed by the U.S. House of Representatives in May — is now in the hands of the Senate. While the legislation covers a wide range of national issues, several key Medicare fee-for-service (FFS) provisions could have a direct and lasting impact on hospitals and health systems.  At DataGen, we’re updating our Potential Changes analysis to reflect the latest proposed policy shifts. Because OBBBA has Medicare FFS implications, DataGen analyzed the impact of these major areas. Here’s a preview of what we’re seeing so far — and what hospital leaders need to keep on their radar:  update to physician Medicare payments using Medicare Economic Index (MEI);  4.0% Pay-As-You-Go (PAYGO) OBBBA sequestration reduction; and  Medicare Disproportionate Share Hospital uncompensated care impact....

  Hospitals must act swiftly  CMS took a decisive step in advancing its mandatory alternative payment model: the Transforming Episode Accountability Model (TEAM). With the release of the federal fiscal year 2026 IPPS proposed rule and a confirmed list of 745 participating hospitals, TEAM is rapidly moving from planning to execution.  The model holds hospitals accountable for Medicare Part A and B spending for 30-day episodes of care related to five major surgical procedures. If costs exceed CMS’ target prices, hospitals will be held financially accountable.  The first wave of baseline data is here  CMS began releasing TEAM performance year 1 baseline data to the first wave of participating hospitals in May, with more hospitals expected to receive data throughout summer and fall. To access their data, hospitals must complete the CMS TEAM Data Request and Attestation Form (DRA) and Data Sharing Agreement (DSA) through the TEAM Participant Portal.   Hospitals ...

Key compliance dates for SPARCS Data: Q4 2024 and Q1 2025 First quarter 2025 Statewide Planning and Research Cooperative System (SPARCS) data submissions are due. In addition, the due dates for the third final warning (June 15) and Statements of Deficiency (July 15) for Q4 2024 are approaching. Here are the key dates hospitals, ambulatory surgery centers and health systems need to know to remain SPARCS compliant.   Q4 2024 SPARCS compliance deadlines  June 15  Final/third warning for Q4 2024 data   Hospitals and ASCs that have not resolved their Q4 2024 data errors after receiving three warnings will be issued an SOD.   July 15  SOD issued for Q4 2024 data   Facilities will be issued an SOD on this date.  Q1 2025 SPARCS compliance deadlines   June 30  Submission deadline for Q1 2025 data   The deadline for submitting Q1 2025 SPARCS data falls on this date. Ensure your data are accurate and submitted on ...

Is your practice ready to meet the latest requirements?  On May 27, DOH released key updates to the Patient-Centered Medical Home (PCMH) enhanced payment program for Medicaid providers. These changes tighten the enhanced payment requirements and introduce new reporting standards tied to Social Care Network (SCN) attestation and quality performance.  If your practice currently relies on PCMH incentive payments, here's what you need to know to stay compliant — and how DataGen can help.  What's changing?  Historically, all New York state PCMH-recognized practices received a $6 per-member-per-month (PMPM) payment for Medicaid patients. That core payment continues — but now, retaining the additional enhanced payment comes with new requirements over the next reporting period years.   Between April 1, 2024 and March 31, 2026:  All PCMH-recognized practices qualify for:  $6.00 PMPM for Medicaid patients; and  $4.00 PMPM for patients up to age 21 or $...