Regulatory Digest

Policy Update – Week of April 7, 2025

Introduction

This Week: Reorg Fallout Continues, RFK Barnstorms on MAHA, Oz Era Begins

Weekly Spotlight

Like last week, we have compiled a lot of the restructuring and administrative news at the end of the newsletter so you can more easily navigate.

Other Regulatory News

Centers for Medicare and Medicaid Services (CMS)

STAT+: Medicare gets a big (unofficial) surprise: a 17-year extension on when it’ll run dry

Medicare’s financial future unexpectedly got a lot rosier, at least according to some federal budget wonks. The Congressional Budget Office recently published its long-term predictions of the federal budget and buried a big surprise for people who follow the Medicare program. The government’s primary piggy bank that pays for Medicare benefits won’t be depleted until 2052 — 17 years later than what CBO analysts predicted last year.

#All

CMS punts on Medicare Advantage AI prior authorization, marketing

CMS finalized a pared-down version of the Biden administration’s 2026 Medicare Advantage proposals.

#All

Trump’s CMS dramatically raises payments to Medicare Advantage plans – Healthcare Dive

The CMS said the hike reflects more recent data on cost growth, though one analyst said the Trump administration “had its finger on the scale.”

#All

Dr. Oz outlines vision for CMS: 8 notes

As Dr. Mehmet Oz completes his first week as the 17th Administrator of the Centers for Medicare & Medicaid Services (CMS), he is sharing his agenda and vision for the agency. A cardiothoracic surgeon and former host of an award-winning TV show, he now leads the largest agency under the Department of Health and Human Services (HHS), with a $1.7 trillion budget, tasked with delivering health outcomes for more than 160 million people.

#All

How ACOs think CMS should change the rules for value-based care

Value-based care providers want the Centers for Medicare and Medicaid Services to commit to stable financing and flexibility as it preps new regulations.

#All

Rural Hospitals Question Whether They Can Afford Medicare Advantage Contracts

Rural hospital leaders are questioning whether they can continue to afford to do business with Medicare Advantage companies, and some say the only way to maintain services and protect patients is to end their contracts with the private insurers. Medicare Advantage plans pay hospitals lower rates than traditional Medicare, said Jason Merkley, CEO of Brookings Health System in South Dakota. Merkley worried the losses would spark staff layoffs and cuts to patient services. So last year, Brookings Health dropped all four contracts it had with major Medicare Advantage companies.

#Hospital, #Patient

Medicare Spends Billions on Oncology Drugs Offering Little Added Benefit

In an analysis of Medicare’s top-selling brand-name oncology drugs, researchers found that while the vast majority provided high added therapeutic benefit, 10 were classified as providing low or no added benefit.

#Patient

Reimbursement hurdles faced by orthopedic surgeons

As payer denials and prior authorization hurdles continue to rise, orthopedic surgeons continue to face pressures to getting paid. Two surgeons connected with Becker’s to share the biggest reimbursement challenges they are currently facing.

#Provider

Health and Human Services (HHS)

Health secretary RFK Jr. declares certain vaccines have ‘never worked,’ flummoxing scientists

Health secretary Robert F. Kennedy Jr. has expressed another unorthodox view on vaccines, with the long-time vaccine critic declaring that vaccines for respiratory bugs that target a sole part of the pathogen they are meant to protect against do not work. The claim was dismissed as erroneous by vaccine experts, who were befuddled by the secretary’s theory, espoused during an interview with CBS News.

#All

RFK Jr. says HHS will determine the cause of autism by September

The nation’s top health agency will undertake a “massive testing and research effort” to determine the cause of autism, Health and Human Services Secretary Robert F. Kennedy Jr. announced Thursday.

#All

Hill Happenings

Senate, House at odds on how to cut Medicaid

Senators proved skittish about massive Medicaid cuts the House favors, setting up a clash as the GOP rushes to extend President Donald Trump’s tax cuts. Conservatives in the House say they won’t back any package without deep cuts that would all but certainly affect the health program. Some Senate Republicans say they won’t accept such cuts.

#All

STAT+: Republicans are proud of creating Medicare Advantage. Now some are urging reform amid runaway costs

Republicans in Congress, long an unwavering source of support for privatized Medicare plans, are increasingly calling for reforms amid widespread evidence that health insurers are abusing the system to collect billions of dollars in unwarranted payments

#All

ACC testifies in Washington to get funding for the HEARTS Act amid big cuts to healthcare

ACC President Christopher Kramer, MD, testified before a Congressional subcommittee to ask for federal funding to support a new law aimed at reducing sudden cardiac arrest deaths, and to support NIH research.

#Patient, #Provider

Notable Notes

Strategies for Sustaining Emergency Care in the United States

The viability of hospital-based emergency care is at risk after facing epidemics, a pandemic, increased patient acuity and complexity, and unsustainable declines in payment, an April 7 RAND report found. In this report, the authors (1) assess the current value of emergency care, (2) evaluate challenges to sustaining emergency care, (3) measure trends in emergency care payment, and (4) identify alternate funding strategies for emergency care. To achieve these objectives, they sought expert input in the form of a study advisory board and conducted interviews and focus groups, a survey, case studies, an environmental scan of peer-reviewed and gray literature, and analysis of administrative data.

#All

Deaths after TAVR are on the rise: Is the pandemic to blame or should cardiologists be concerned?

COVID-19 may help explain the increased rates of cardiac and noncardiac mortality among TAVR patients, but there are several other factors to consider as well. Researchers explored nearly 11 years of STS/ACC registry data to learn more.

#Device, #Patient

LuX-Valve Shows Promise, a Nod to Growing Diversity of TTVR Devices

The global flurry of innovation in tricuspid valve interventions continues in the wake of Evoque’s release, as illustrated by the 1-year report for a Chinese-made device that has already progressed to a second-generation iteration.

#Device, #Patient