Below are links for my stories about Centers for Medicare and Medicaid Services (CMS), which is by far the biggest purchaser of health care in the United States. Click here for my reverse timeline of interesting CMS decisions.
CMS decisions directly affect the treatment of about 139 million people. (About 65 million were enrolled in Medicare as of 2022 and 86 million in Medicaid as of February 2023, with perhaps 12 million people having conditions that qualify them for both programs.)
Medicare policies influence not only those of commercial insurers, but the decisions that companies make about which products to develop. If you want to learn more about that, consider buying this STAT Report, Decoding Medicare: 10 key decisions and how they’re made. Or get in touch if you have ideas on this subject to pitch me.
Recent stories
Medicare Will Speed Coverage of Some ‘Breakthrough’ Medical Devices, Oct. 3, 2024. Medscape Medical News.
‘Egregious’ Ustekinumab Part D Price Jump Shows Need for IRA, Experts Say, Aug. 30, 2024. Medscape Medical News.
New Medicare Codes Seen Elevating Role of Patient Navigators, Aug. 27, 2024. Medscape Medical News.
Medicare Proposes Effective 3% Pay Cut for Docs for 2025, July 11, 2024. Medscape Medical News
Study Raises Concerns About Rising Cost of Diabetes Meds, May 31, 2024. Medscape Medical News.
Medicare Doc Pay Cut Eased as Biden Signs Federal Spending Bill, March 12, 2024. Medscape Medical News
Federal Bill Seeks AI Tools to Stop Medicare Fraud, Feb. 1, 2024. Medscape Medical News
Panel Recommends Small Bump in 2025 Medicare Physician Pay, Jan. 12, Medscape Medical News
Grail Gets FDA OK for Study of Cancer Blood Test, Nov. 27, 2023. Medscape Medical News.
Medicare 2024 Base Rate Cut Triggers Calls for Pay Overhaul, Nov. 3, 2023. Medscape Medical News.
Lack of Medical Device Tracking Leaves Patients Vulnerable, Sept. 27, 2023. Medscape Medical News.
CPT Updates for 2024 Include New RSV Vaccines, Spanish Translation, Sept. 14, 2023. Medscape Medical News.
Medicare Announces 10 Drugs Targeted for Price Cuts in 2026, Aug. 29, 2023. Medscape Medical News.
Take 2: CMS Launches Successor to the Oncology Care Model, June 30, 2023. Medscape Medical News.
Proposal to Cap Part B Pay on Some Drugs Draws Opposition, June 20, 2023. Medscape Medical News.
“For many who use power wheelchairs, CMS decision just made seat elevation much less expensive,” STAT, June 6, 2023
“Will Medicare cover it? Drugs like Aduhelm are challenging its standard,” STAT, May 25, 2023
“Decoding Medicare: 10 key decisions and how they’re made,” STAT Report, May 2023
CRC Blood Tests: A Future Without Screening Colonoscopies?, April 5, 2023. Medscape Medical News.
Only Physicians With Relevant Expertise Should Handle Prior Authorization Disputes: Doctors Groups, March 3, 2023. Medscape Medical News.
Navigating Medicare Insulin Coverage Still Requires Caution, Jan. 18, 2023. Medscape Medical News.
Medicare Pay Cuts Partly Averted in Massive Budget Bill, Dec. 27, 2022. Medscape Medical News.
CMS Proposes Bid to Speed Up Insurers’ Prior Authorization Decisions, Dec. 12, 2022. Medscape Medical News.
Law Gives Some Relief on Cancer Drug Costs, but More Help Needed, Dec. 12. Medscape Medical News.
Will ICER Review Aid Bid for Medicare to Pay for Obesity Drugs?, Nov. 21, 2022. Medscape Medical News.
Good News, Bad News for GI in 2023 CMS Physician Fee Schedule, Nov. 21, 2022. Medscape Medical News.
New Medicare Physician Fee Schedule Leaves Docs Fuming Over Pay Cuts, Nov. 4, 2022. Medscape Medical News.
CMS Spent $18 Billion on Drugs Without Confirmed Benefits, OIG Report Finds, Sept. 30, 2022. Medscape Medical News.
Medicare Drug Changes Ought to Benefit Rheumatology Patients, Aug. 31, 2022. Medscape Medical News.
Problems With Drugs That Get Speedy OKs: What To Do? Aug. 25, 2022. Medscape Medical News.
House Could Soon Give Biden Win on Medicare Drug Negotiations, Insulin Costs, Aug. 10, 2022. Medscape Medical News.
Advocates, hospitals at odds about CMS plan to suppress a patient-safety score, July 12, 2022. Association of Health Care Journalists website.
Medicare Proposes Physician Pay, Policy Changes Through Fee Schedule, July 8, 2022. Medscape Medical News.
Hospitals, HHS each scored a win and a loss in recent Supreme Court cases, with Joseph Burns, July 6, 2022. Association of Health Care Journalists website.
Lawmakers Argue for Changes in Prior Authorization Processes, June 30, 2022. Medscape Medical News.
Supreme Court Rules Against Medicare Pay Cut on Discounted Drug, June 16, 2022. Medscape Medical News.
Docs Get Some Catch-Up Time to Report Aid Payments During COVID; Is It Enough Time? April 7, 2022. Medscape Medical News.
Democrats Discuss Ideas for Expanding US Health Coverage, March 30, 2022. Medscape Medical News.
Physician Groups Argue for Increase in 2023 Medicare Payment, March 16, 2022. Medscape Medical News.
High Praise, Condemnation for CMS Aduhelm Coverage Plan, Feb. 16, 2022. Medscape Medical News.
Tips for covering Medicare’s plan to limit coverage of controversial Alzheimer’s drug, Jan. 25, 2022. Association of Health Care Journalists website.
Outrage, Praise for CMS’ Proposed Aducanumab Payment Policy, Jan. 13, 2022. Medscape Medical News.
MedPAC Draws AMA Ire With Vote on 2023 Physician Pay, Jan. 14, 2022. Medscape Medical News.
Outrage, Praise for CMS’ Proposed Aducanumab Payment Policy, Jan. 13, 2022. Medscape Medical News.
Medicare Intends to Limit Payment for Controversial Alzheimer’s Drug, Jan. 11, 2022. Medscape Medical News.
One-year postpartum Medicaid coverage: Are states ready to offer it soon?, Jan. 11, 2022. Association of Health Care Journalists website.
Medicare Seeks to Cut Drug Costs for People in Part D Plans, Jan. 10, 2022. Medscape Medical News.
Medicare Premium Hike Reassessed Due to Aduhelm Price Cut, Jan. 10, 2022. Medscape Medical News.
Medicare Insulin Negotiations Seen Saving $17 Billion, Dec. 14, 2021. Medscape Medical News.
Cancer Hospitals Fail to Reveal Prices: ‘It’s Not Always Shopable’, Dec. 2, 2021. Medscape Medical News.
Posted Prices of Cataract Procedures May Confuse Patients: Study, Oct. 12, 2021. Medscape Medical News.
(Story looks at early implementation of the CMS rule on posting of hospital prices for procedures.)
Paying Less for Drugs With Problematic Approvals, Sept. 29, 2021. Medscape Medical News.
Medicare Hospital Pay ‘Bankruptcy’ Deadline Remains 2026, Sept. 1, 2021. Medscape Medical News.
Biden Plans to Tie Vaccines for Nursing Home Staff to Federal Funding, Aug. 19, 2021. Medscape Medical News.
Study estimates how often people on Medicare may be harmed by ‘low-value’ care, Aug. 19, 2021. Association of Health Care Journalists website.
Biden Calls for Medicare Negotiation on Some Drug Prices, Aug. 12, 2021. Medscape Medical News.
Cut Aducanumab Cost, Speed Confirmatory Research, ICER Says, Aug. 5, 2021. Medscape Medical News.
DOJ Joins Cases Alleging False Diagnoses by Kaiser MA Plans, Aug. 3, 2021. Medscape Medical News.
AHA Concerned, Others Pleased by Draft Penalty Hike on Transparency Rule, July 20, 2021. Medscape Medical News.
No Net Benefit of Aducanumab for Alzheimer’s Disease, Expert Panel Rules, July 16, 2021. Medscape Medical News.
Medicare Proposes Direct Payments to PAs, Telehealth Expansion, July 14, 2021. Medscape Medical News.
Contentious Alzheimer’s Drug Likely to Get National Coverage Plan, CMS Says, July 13, 2021. Medscape Medical News.
Biden Calls for Action on Hospital Mergers, Drug Costs, Hearing Aids, July 12, 2021. Medscape Medical News.
Federal Plan to End Surprise Medical Bills Draws Mixed Reactions, July 7, 2021. Medscape Medical News.
Lawmakers Seek to Address Medicare Vaccine ‘Sticker Shock,’ June 28, 2021. Medscape Medical News.
Biden Budget Requests Steep Increases for NIH, CDC, SAMHSA, May 28, 2021. Medscape Medical News.
Senate Confirms Veteran Health Policy Expert to Lead CMS, May 26, 2021. Medscape Medical News.
MedPAC Proposes Path for Post-Pandemic Medicare Telehealth Pay, March 17, 2021. Medscape Medical News.
How the New ‘Patient Price Shopping’ Rule Can Affect Your Practice, March 15, 2021. Medscape Medical News.
Medicaid Physician Fees Still Lag Medicare Payment Rates, Feb. 9, 2021. Medscape Medical News.
Medicaid to Cover Routine Costs for Patients in Trials, Dec. 30, 2020. Medscape Medical News.
Judge Delays Rule That Cuts Pay for Drugs in Docs’ Offices, Dec. 28, 2020. Medscape Medical News.
Medicare Finalizes 2021 Physician Pay Rule With E/M Changes, Dec. 2, 2020. Medscape Medical News.
Trump Releases Medicare Part B, Part D Drug-Cost Rules, Nov. 23, 2020. Medscape Medical News.
Medicare Faces Calls to Stop Physician Pay Cuts in E/M Overhaul, Oct. 14, 2020. Medscape Medical News.
Questions Persist About Trump Plan for Medicare Drug Discount Cards, Sept. 25, 2020. Medscape Medical News.
Medicare Will Test Pay Models for Radiation Oncology, Dialysis, Sept. 18, 2020. Medscape Medical News.
New Billing Code for Added COVID Practice Expense, Sept. 11, 2020. Medscape Medical News.
AMA Releases 2021 Overhaul of E/M Service Codes, Sept. 1, 2020. Medscape Medical News.
Covering Medicaid during the COVID-19 pandemic: 6 things journalists should know
The expanding role of Medicaid in US health care: A research roundup
Medicare Sticks With E/M Pay Plan Over Some Groups’ Objections, Aug. 4, 2020. Medscape Medical News.
AMA Seeks Medicare Repayment Delay, HHS Extends Aid Deadline, Aug. 3, 2020. Medscape Medical News.
Trump Signs Four Executive Orders Aimed at Cutting Drug Prices, July 27, 2020. Medscape Medical News.
CMS Seeks Feedback on Electronic Opioid Prescribing Rules, July 31, 2020. Medscape Medical News.
Medicare to Cover Gene Tests in Inherited Breast and Ovarian Cancer, Jan. 29, 2020
Rand analysis of proposed Medicare buy-in uncovers surprising findings, Nov. 18, 2019. MD Edge | Internal Medicine
HHS Kicks Off Battle for More Price Transparency in Healthcare, Nov. 15, 2019. Medscape Medical News.
CMS Sharpens Weapon to Kick ‘Problematic’ Docs Out of Medicare, Nov. 7, 2019. Medscape Medical News.
CMS Releases Final Physician Fee Schedule With ‘Significant’ E/M Overhaul, Nov. 4, 2019. Medscape Medical News.
Health Care Debates, a comprehensive report done for CQ Researcher, Oct. 18, 2019.
Medicare Drug-Negotiations Bill Approved by House Committees, Oct. 18, 2019. Medscape Medical News.
New Report Shows Costs, Benefits of Varied Healthcare Reforms, Oct. 17, 2019. Medscape Medical News.
Medicare Proposes Overhaul to ‘Kickback’ Laws, Oct. 9, 2019. Medscape Medical News.
Medicare Plan for E/M Pay Draws Some Specialties’ Opposition, Oct. 4, 2019. Medscape Medical News.
Trump Executive Order Seeks Proposals on Medicare Pay for NPs, PAs, Oct. 3, 2019. Medscape Medical News.
Rule Buried in Proposed Medicare Fee Schedule Could Have ‘Chilling Effect,’ Oct. 1, 2019. Medscape Medical News.
Medicare Announces Coverage for CAR T-Cell Therapy, Aug. 8, 2019. Medscape Medical News.
Senate Committee Approves Plan to Alter Medicare Drug Pay, July 26, 2019. Medscape Medical News.
White House Drops Bid to Redirect Drug Rebates to Seniors, July 11, 2019. Medscape Medical News.
Medicare-for-All Could Have Benefits, Drawbacks, CBO Report Says, May 2, 2019. Medscape Medical News.
Medicare-for-All Gets First Formal Hearing on Capitol Hill, May 1, 2019. Medscape Medical News.
Congress Faces Challenge With Future Medicare Physician Pay, April 23, 2019. Medscape Medical News.
Sunshine Act May Reduce Patient Trust in Physicians, April 16, 2019. Medscape Medical News. Story about papers published in JAMA Network Open looking at the CMS’ Open Payments database of industry payments to physicians.
Medical Groups Support Bid to Add 15,000 Residency Slots April 15, 2019. Medscape Medical News.
Medicare Moves Closer to CAR-T Coverage Policy, Feb. 18, 2019. Medscape Medical News.
HHS Seeks Major Change in Part D, Medicaid Drug Purchasing, Feb. 1, 2019. Medscape Medical News.
Congressional Committees Target Insulin, Rising Drug Prices Jan. 30, 2019. Medscape Medical News.
Congress, CMS Taking Key Steps to Examine Drug Costs, Jan. 10, 2019. Medscape Medical News.
Most 2017 Participants in MIPS Qualified for Small Bonus, Nov. 9, 2018. Medscape Medical News.
How to Increase Access Cancer Drugs Discussed at NCCN Meeting, Sept. 25, 2018. Medscape Medical News. Story discusses Medicare’s payment policies for cancer drugs.
Groups Pan Proposed Medicare Changes on Office Visits, Drugs , Sept. 13, 2018. Medscape Medical News. The AMA cited a ‘groundswell of opposition’ to a proposed payment change for routine office visits, joining other medical groups and AARP in criticizing the CMS proposal.
ACOs Produce $314 Million in Net Medicare Savings, Group Says, Sept. 4, 2018. Medscape Medical News.
CMS Advisers Back Patient Reporting Tools for CAR-T Drugs, Aug. 23, 2018. Medscape Medical News. A panel of experts voted in support of four tools for collecting patient-reported outcomes that Medicare could factor into payment decisions for costly CAR-T cancer drugs.
Groups See Progress in CMS’s EHR Approach in Hospital Rule, Aug. 7, 2018. Medscape Medical News.
AAFP, Insurers Back Medicare Bid for ‘Site-Neutral’ Pay Aug. 2, 2018. Medscape Medical News.
Cancer Groups Object to Medicare Proposals to Cut Part B, July 19, 2018. Medscape Medical News.
Medicare Will Likely Face Pushback on Physician Pay Changes July 18, 2018. Medscape Medical News.
Practice-Hospital Consolidation Increasing for Many Specialties July 13, 2018. Medscape Medical News.
DEA Revises Opioid-Quota Rules, Leaving Out Requested Change July 13, 2018. Medscape Medical News.
Medicare Proposes Major Physician Bookkeeping, Pay Changes July 12, 2018. Medscape Medical News.
CMS Seeks Feedback on Physician Self-Referral Law, June 22, 2018, Medscape Medical News.
Most MIPS-Eligible Physicians Participated in First Year ,Medscape Medical News, June 6, 2018.
CMS to Recast ‘Meaningful Use’ Data Reporting Rules Medscape Medical News, April 25, 2018.
Medicare Paid for Telehealth Services That Didn’t Meet Its Rules , Medscape Medical News, April 18, 2018.
CMS Allows More Leeway on Required Insurance Benefits, Medscape Medical News, April 10, 2018.
Medicare Changes Opioid, Generic Policies for Part D Plans Medscape Medical News, April 3, 2018.
Medicare Changes Opioid, Generic Policies for Part D Plans , Medscape Medical News, April 3, 2018.
CMS to Recast ‘Meaningful Use’ Data Reporting Rules April 25, 2018. Medscape.