On July 15, the Centers for Medicare & Medicaid Services (CMS) released the CY 2026 Proposed Rule for the Medicare Outpatient Prospective Payment System (OPPS). The proposed rule introduces several significant policy changes that will impact hospitals and ambulatory surgical centers (ASCs) beginning Jan. 1.  From updates to the 340B payment policy and ambulatory payment classifications (APCs) to the elimination of the Inpatient-only (IPO) list and expanded reporting requirements, the CY 2026 OPPS rule is one of the most comprehensive updates in recent years.   CMS projects an overall $1.61 billion increase in OPPS payments before accounting for the 340B remedy offset, which is expected to reduce payments by $1.1 billion, resulting in a net increase of approximately $510 million.  This blog post breaks down the most important proposed changes, financial impacts and reporting requirements so your organization can prepare for compliance and optimize reimbursement strateg...

On July 14, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2026 proposed rule for the Medicare Physician Fee Schedule (PFS) . This annual update outlines changes to physician payment rates, policy refinements and adjustments to programs that affect healthcare providers nationwide. If finalized, the proposed updates will take effect for services provided on or after Jan. 1, 2026.  The rule introduces appreciable revisions that impact payment methodology, practice expense allocations and data sources used for setting reimbursement rates. Below are the most critical takeaways for healthcare providers and stakeholders.  Key proposed changes to the CY 2026 Medicare PFS proposed rule  CMS’s proposed changes address several major policy areas, including:  payment rate updates;  Relative Value Unit (RVU) updates;  GPCI updates;  Rural Health Clinics and Federally Qualified Health Centers;  Ambulatory Specialty Model...

On June 30, Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Home Health Prospective Payment System (HH PPS) proposed rule . This annual rule outlines significant changes to Medicare home health payment policies, including rate adjustments, Patient-Driven Groupings Model (PDGM) recalibration, quality reporting updates and value-based purchasing modifications.  For home health agencies (HHAs), this year’s proposed rule carries major financial and operational implications. CMS estimates an overall $1.135 billion decrease in aggregate payments in CY 2026 compared to CY 2025, largely driven by permanent behavioral adjustments, temporary payment recoupments and changes to outlier payment thresholds.  In addition to payment updates, the rule introduces policy revisions to the Home Health Value-Based Purchasing (HHVBP) model, face-to-face encounter requirements, provider enrollment safeguards and durable medical equipment regulations.   Ove...

 Updated on July 9, 2025 The One Big Beautiful Bill Act (OBBBA) — a major budget reconciliation bill passed by the U.S. House of Representatives in May — became law on July 4. 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.  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;  potential 4.0% additional Pay-As-You-Go (PAYGO) sequestration reduction; and  Medicare Disproportionate Share Hospital uncompensated care impact.  1. Physician payment updates   For the calendar year 2026, physician payments are slated to increase by 2.5%.   2. The potential new 6% sequester  With the new legislation, Congress may allow the Statutory...

When you partner with DataGen and use our Medicare fee-for-service policy analytics solution, you receive Medicare IPPS proposed rule payment briefs, along with additional essential Medicare fee-for-service (FFS) updates and materials throughout the year.   DataGen provides an overview of the Centers for Medicare and Medicaid Services’ (CMS) federal fiscal year (FFY) 2026 proposed rule for the Medicare Inpatient Prospective Payment System (IPPS)    Overview of policies for the FFY 2026 IPPS new proposed rule The DataGen Medicare FFS policy analytics team summarized and analyzed the following policy changes in the new proposed rule:  utilizing FFY 2024 Medicare Provider and Review (MedPAR) and FFY 2023 Hospital Cost Reporting Information System (HCRIS) data for standard calculations;  updates to the Medicare Disproportionate Share Hospital (DSH) payment policies, including hospital eligibility for DSH Uncompensated Care (UCC) payments in FFY 2026 being...

The implications of Medicare payment policy changes can be both significant and complex. For healthcare providers, hospital administrators and policy analysts, understanding these potential adjustments is essential for financial planning and advocacy.   DataGen’s recently released 2025 Potential Medicare Changes Analysis report offers an in-depth evaluation of how proposed changes could impact Medicare fee-for-service (FFS) payments across various care settings, including inpatient hospitals, skilled nursing facilities, home health agencies and more.  Here’s a breakdown of the key findings and insights from our report, providing annual impact estimate breakouts for all proposals from 2026 to 2035.*  What DataGen’s potential Medicare changes analysis covers  The potential Medicare changes analysis reviews Medicare payment scenarios policymakers are considering to achieve long-term deficit reduction and improve payment policies. It evaluates the financial impact o...

The pursuit of health equity in the United States has become more critical as healthcare disparities continue to affect millions of Americans. Socioeconomic status and access to healthcare services are pivotal in determining health outcomes, leaving underserved populations at a disadvantage. To address these issues, the Centers for Medicare and Medicaid Services (CMS) introduced changes in the Medicare Value-Based Purchasing (VBP) Program to incentivize quality care for all.  In this blog, we provide an update, discuss recent data and analyze the national impact. Read on for our interpretation of the CMS VBP Program and how it aims to advance health equity.   Understanding the Hospital VBP Program  The Hospital VBP Program aims to reward acute care hospitals with incentive payments based on their quality of care. This initiative ties a portion of Medicare payments to performance on quality measures, putting 2.0% of a hospital's base operating IPPS revenue at risk. CM...

Key IPPS updates you need to know about  On April 10, Centers for Medicare & Medicaid Services (CMS) released the federal fiscal year (FFY)   2025 Medicare Inpatient Prospective Payment System proposed rule . This rule proposes significant changes and updates to Medicare fee-for-service (FFS) payments and policies.  Understanding these changes is crucial for healthcare professionals, state hospital associations and multi-state health systems. This blog aims to break down the key points and implications of this proposed rule to help you stay informed and prepared.  Overview of the proposed rule  The proposed rule includes regular updates to wage indexes and the market basket. Below are some policies being proposed.  1. Data utilization for standard calculations  CMS plans to use FFY 2023 Medicare Provider Analysis and Review (MedPAR) claims data and FFY 2022 Hospital Cost Reporting Information System (HCRIS) data for standard calculations. Using Med...

Healthcare providers face difficult choices that can pit their number one priority ─ care quality ─ against the need to reduce costs and increase efficiency. Healthcare providers can achieve all of these goals using data analytics. An analytics-first strategy enables hospitals, health systems and state hospital associations to make data-informed decisions, not best guesses. This proactive approach can illuminate trends and provide real-time insights that are often hidden or seen too late to change outcomes. Data from your Medicare quality programs tell a compelling story, 24 hours a day, 365 days a year. DataGen uses Medicare impact modeling, expert analysis and visualizations to reveal data-informed narratives about your performance on three CMS programs: Value-Based Purchasing (VBP); Readmission Reduction Program (RRP); and Hospital-Acquired Conditions (HAC) Reduction Program. Do you know your organization’s stories? The biggest and best tool in your healthcare management toolkit: ...