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...

Federal legislative and regulatory measures enacted since 2010 have fundamentally altered Medicare provider payments — and consequently, the operational landscape for hospitals across the United States. As part of an ongoing dialogue on health policy reform and fiscal strategy, it's crucial for hospital administrators and healthcare professionals to understand the breadth and depth of these payment adjustments.  That's why DataGen released the Enacted Medicare Cuts Analysis as part of our legislative analyses suite, which is intended for advocacy purposes only.  We looked at the extent to which hospitals have been impacted by existing Medicare provider payment cuts that Congress has enacted to achieve Medicare payment policy and/or long-term deficit reduction goals. The impacts shown in this analysis include the major cuts enacted since 2010.  In this blog, we'll cover the enacted legislative cuts, enacted regulatory cuts and quality programs analyzed in the Enacted Medi...

CMS’ proposed Calendar Year 2024 Medicare Home Health Prospective Payment System rule includes updates to: the Patient-Driven Groupings Model, Low Utilization Payment Adjustment thresholds, functional levels and comorbidity adjustment subgroups; estimated aggregate payments based on the 30-day payment rate to account for assumed versus actual behavior changes; the HH Value-Based Purchasing and Quality Reporting programs; home intravenous immune globulin items and services, and disposable negative pressure wound therapy device payment rates; medical equipment and supplies, including competitive bidding, as outlined by the Consolidated Appropriations Act of 2023; and provider and supplier enrollment requirements and oversight. The HH PPS rule also proposes to add a new Special Focus Program for low-performing hospices. CMS estimates that the rule will cut aggregate HH agency payments by $375 million nationally. This includes a -1.81% adjustment in the HH annual standard payment rate. Th...

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: Da...

CMS will implement a new Rural Emergency Hospital provider type on Jan. 1. REHs will be able to provide certain outpatient hospital services including emergency department and observation services. CAHs and small rural acute care hospitals with no more than 50 beds are eligible to enroll as REHs under Medicare if they meet certain criteria. If you're considering converting a rural hospital or Critical Access Hospital to an REH, you can submit your application . You can also learn more about becoming an REH Medicare provider . REHs will be paid under the Medicare Outpatient Prospective Payment System payment rates, plus 5.0%. CMS will also include a fixed monthly payment, based on the excess of the total amount paid to all CAHs in 2019 over the estimated total amount that would have been paid to CAHs in 2019 if payment were made for inpatient, outpatient and skilled nursing facility services under the PPS. In the future, the monthly payment will be based on 2023 data, increase...

The good news: The Medicare Shared Savings Program (MSSP) has reported a fifth consecutive year of savings while delivering high-quality care for Medicare beneficiaries in accountable care organizations (ACOs). The tricky news: With participation dropping since performance year 2018, ACOs will need places to pivot as success becomes more dependent on risk progression, benchmarking and equity goals. The 2021 MSSP results CMS reported the following highlights from the 2021 MSSP performance year : 99% of participants met the quality targets required for shared savings; 58% earned shared savings; ACOs outperformed non-MSSP providers in metrics related to diabetes, blood pressure, select cancers, fall risk, flu vaccination, tobacco screening and smoking cessation, and screening/remission for depression. ACOs with specific characteristics saved more than their counterparts. This includes ACOs labeled low revenue and those dominated by primary care providers. For example, low-revenue ACOs sa...

Another round of major healthcare financial cuts is possible—and their impact could be devastating. As healthcare policymakers and analysts try to mitigate the high cost of healthcare in the United States, payment reform is already making an impact on the way provider organizations do business. DataGen recently released projections revealing the impact of cuts made in Medicare payments to hospitals and hospital systems across the nation over the last 16 years. These cuts were partially offset by the coverage increases under the Affordable Care Act (ACA). As the new administration turns its attention to healthcare, however, there are more potential cuts on the table. If these cuts are enacted—and if done so while the coverage expansion provided by the ACA is repealed or changed—healthcare organizations face a major risk of a massive decrease in funding.