Healthcare Financial Management

For the second consecutive year, a federal judge has provided relief to plaintiffs challenging Trump administration regulations that are intended to set limits on Affordable Care Act (ACA) marketplace coverage. A July 16 ruling by Judge Brendan Hurson with the U.S. District Court for Maryland halted implementation of key provisions in recently finalized regulations that would have taken effect July 20, generally applying to marketplace operations for plan year 2027.

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This spreadsheet compares relative weights and payment rates for ASC covered surgical procedures at the HCPCS level, using the 2027 proposed rule Addendum AA compared to 2026 Addendum AA (July 1, 2026, file), as downloaded from the CMS website. Each spreadsheet includes an HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.

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Physicians will incur a payment decrease in 2027 unless Congress intervenes, according to a CMS proposed rule issued July 14 for the Medicare Physician Fee Schedule. Statutory provisions call for increases of 0.75% for clinicians participating in advanced alternative payment models (APMs) and 0.25% for nonparticipants.

CMS released the calendar year 2027 proposed rule for Medicare’s hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system (CMS-1850-P) on July 2, 2026. Policies in the proposed rule will generally go into effect on January 1, 2027, unless otherwise specified. The proposed rule was published on July 7, 2026, in the Federal Register. The public comment period will close on August 31, 2026.

A formerly high-revenue healthcare service has been diminished on several fronts in 2026. Medicare Part B spending on skin substitutes increased by 640% between 2022 and 2024, reaching nearly $3 billion per quarter, according to a government report. Steps taken by CMS and policymakers to counter that trend include an overhauled payment system and an increased focus on finding fraud, waste and abuse.

Hospitals and health systems’ relationship with AI is getting more refined as industry executives figure out what they want and don’t want from the software. For hospital and health system executives, that means identifying when their ROI in a given AI application is good enough to keep it in use, and depending on the use, deciding if it is worth keeping a separate vendor around to manage that function.

Hospital leaders understand better than most that health is not abstract. Every day, they see what happens when chronic conditions go unmanaged, behavioral health needs go unsupported and patients enter the system later than they should. Yet, when hospitals look inward at their own workforce, medical management is still too often treated as a benefits function rather than a workforce strategy. That is a missed opportunity. Hospitals are among the nation’s most complex employers.