Weekly Spotlight

Our spotlight this week continues to be on federal employees: the ones who were fired or took early retirement, the ones who remain and don’t know what the future holds, and the ones who are still trying to get the job done not knowing if it will make a difference anymore. I frequently remark that DC is a company town. Nearly everyone here works for a branch of government or has work related to a branch of government. There isn’t a single family in the DMV (District, Maryland, and Virginia) that hasn’t been impacted by these cuts. The vast majority of these people are doing the work because they believe in something bigger than themselves. They could be taking their immense talents to the private sector, but they chose public service instead. This used to be something we, the people, valued. It is not anymore.

So as we turn our attention to the programs and support systems that are unraveling before our eyes, and the people who will be irreparably harmed by their decimation, let’s not forget about the people who have kept them afloat for so long.

Other Regulatory News

Centers for Medicare and Medicaid Services (CMS)

Trump to end federal funding of certain non-medical services in Medicaid

The Trump administration said it will no longer help states fund non-medical services that often are aimed at improving housing and nutrition for people in the Medicaid program. The change is a departure from the Biden administration’s efforts to improve the health of Medicaid enrollees by paying for non-medical services.

#All

Trump order seeks changes to Medicare drug price negotiation program, PBM reform

The Executive order seeks to alter the existing framework of drug price negotiations under Medicare, potentially impacting how prices are set for medications covered by the program and emphasizes the need for reforming Pharmacy Benefit Managers, which play a significant role in managing prescription drug benefits and negotiating prices with pharmaceutical companies. hese proposed changes are part of a broader effort to address healthcare affordability.

#Drug, #Patient, #Payer

CMS’ proposed pay bump for does little for hospitals’ ‘twin problems’

The 2.4% increase consists of a 3.2% market basket update negated by a 0.8% productivity cut, which hospital leaders argue is insufficient given the financial pressures they face.

#Hospital

Food and Drug Administration (FDA)

RFK Jr. attempts to rally FDA workers to his MAHA agenda

In a recent speech to FDA employees, Robert F. Kennedy Jr. outlined his “Make America Healthy Again” (MAHA) agenda, emphasizing the need for the FDA to prioritize tackling childhood chronic diseases. He criticized regulatory agencies for being influenced by the industries they oversee, suggesting a disconnect between their missions and current practices.

#All

FDA Reverses Course on Telework / Hires Contractors After Layoffs and Resignations Threaten Basic Operations

FDA faced critical staffing shortages due to employee resignations and layoffs, prompting concerns about its ability to function effectively. In response to these challenges, the FDA has decided to allow more flexibility in telework arrangements for its employees, aiming to retain staff and stabilize operations. The FDA plans to hire contractors to take over responsibilities previously handled by some of its employees affected by recent layoffs at HHS

#All

Opinion: Five priorities to remake the FDA in a time of deep uncertainty

The authors, both former FDA leaders, argue that this moment calls for a recalibration of the FDA’s priorities rather than a retreat from its mission. The article emphasizes the importance of enhancing the capabilities of FDA review teams, advocating for smart recruitment and a culture that values scientific rigor to ensure timely approvals of life-saving products. It stresses the need to maintain the FDA’s independence, ensuring that decisions are based on science rather than political motivations, which is crucial for public trust. The authors call for modernization of research regulations to facilitate better post-market evidence generation and to make the U.S. the preferred location for testing innovative therapies. Improving methods of safety assessment is deemed essential to bolster public confidence in medical products, including vaccines. The article concludes by urging Makary to prioritize science, transparency, and integrity in his leadership to strengthen the FDA’s role for future generations, as both the biotech industry and the public depend on it.

#All

NEJM AI’s editor-in-chief on FDA approval vs. clinical effectiveness

Isaac “Zak” Kohane, the editor-in-chief of NEJM and chair of biomedical informatics at Harvard Medical School, emphasizes the importance of testing AI, particularly tools like ChatGPT, in clinical trials to evaluate their effectiveness compared to traditional medical advice. He suggests that AI advice should be compared not just to physician recommendations but also to the alternative of patients opting out of seeking medical advice altogether. Kohane notes that excluding the best possible control group in AI effectiveness studies can hinder understanding of AI’s advantages over other methods.

#Patient, #PROVIDER

Health and Human Services (HHS)

Severe and irreversible consequences’: HHS dismantling sparks calls for reinstatements, RFK Jr.’s resignation

The article discusses the dismantling of the Department of Health and Human Services (HHS) and the resulting backlash, which includes calls for the reinstatement of previous officials and the resignation of Robert F. Kennedy Jr. (RFK Jr.).

#All

Key NIH grant review panels resume meeting, but are not ‘back to normal’

Key National Institutes of Health (NIH) grant review panels, which had been suspended during the early days of the Trump administration, have resumed. However, in 2025, the NIH has awarded $2.8 billion less in funding compared to the average for the same period over the previous five years, indicating that while meetings have resumed, the funding landscape is still not fully back to normal.

#All

U.S. health agencies are coming unglued

RFK Jr. has pledged to overhaul the U.S. health care system, aiming for significant reforms that challenge the status quo, and he seems to be accomlishing that all at once. Beyond the thousands of workers laid off and programs shuttered, the Trump administration’s remaking of the Department of Health and Human Services — in a matter of weeks — is now sparking basic questions about how parts of the agency and those it oversees can continue to function. Thousands of workers have been laid off, numerous programs have been shut down. Lab leaders at the NIH are scrambling to buy food for animals. Scientists are hoarding and rationing reagents. FDA employees are bracing for fewer inspections because, even though the inspectors still have their jobs, support staff do not.

#All

Internal budget document reveals extent of Trump’s proposed health cuts

The Trump administration’s proposed budget leaked earlier this week, revealing his plans to cut the Department of Health and Human Services (HHS) budget by approximately 30%, which would significantly reduce federal health programs. The National Institutes of Health (NIH) would see a 40% budget cut, reducing its funding from over $47 billion to $27 billion. This includes consolidating its 27 institutes into eight and eliminating some entirely. The Centers for Disease Control and Prevention (CDC) would have its budget slashed from $9.2 billion to $5.2 billion, leading to the elimination of domestic HIV and chronic disease programs, as well as initiatives for obesity and smoking cessation. A new agency, the Administration for a Health America (AHA), would be established with a $20 billion budget, consolidating functions related to HIV, environmental health, and primary care. Programs managed by the Health Resources and Services Administration, particularly those supporting rural hospitals and health initiatives, would also face severe cuts. The Food and Drug Administration (FDA) would receive sufficient funding to maintain its authority to collect industry fees, which are crucial for expediting safety reviews. The administration is also proposing to create a new office of the chief technology officer within the federal health department that would house the Assistant Secretary for Technology Policy, the department’s health IT regulator, and an “Office of Chief Information.” Under the proposal, ASTP would be funded with $9 million, compared to the $66 million appropriated in the 2023 budget.

#All

Former USPSTF Members Ask HHS for Protection

Dozens of former chairs, members, and scientific directors of the U.S. Preventive Services Task Force (USPSTF) urged HHS Secretary Robert F. Kennedy Jr. to protect its ability to improve people’s health through primary care services. In a letter to Kennedy, they outlined two potential threats to the task force: a legal case involving insurance coverage for recommended preventive care, and the recently announced reorganization and workforce reductions at HHS.

#All

Trump fired the top HHS watchdog. She says the future of health care oversight is grim if partisanship wins ouy

Christi Grimm, the former inspector general of the Department of Health and Human Services speaks out after being fired. Trump has nominated Thomas March Bell, a Republican attorney known for investigating Planned Parenthood, to replace Grimm, further emphasizing the shift towards partisan appointments in oversight roles.

#All

Hill Happenings

BPC Explains: What is a Recission Request and What does that Mean

The White House will soon ask Congress to cancel $9.3 billion already approved for foreign aid initiatives, public broadcasting and other programs, according to a White House official. A rescission is a request to rescind funds that were previously appropriated by Congress. If Congress approves the president’s rescission proposal, it would mean that particular appropriation would no longer be available to the agency to spend. If Congress doesn’t approve the president’s rescissions within 45 days, the president has to release the rescinded monies to the agencies.

#All

Doggett, Murphy Call for Independent Investigation into Medicare Advantage Organizations

Reps. Lloyd Doggett (D-Texas) and Greg Murphy (R-N.C.), ask the GAO to investigate whether the privately run alternative to Medicare, which enrolls more than 33 million Americans, skirts federal requirements to spend at least 85 percent of revenue on health care for beneficiaries. Doggett and Murphy cite concerns that insurers’ rapid purchasing of health care providers over the past few years could help the companies bypass those requirements by allowing them to count payments to the providers they own as “payments for medical expenses.” Those payments “may ultimately be profits” for the insurers, the lawmakers wrote.

#Payer, #Patient, #Provider

Notable Notes

Harvard rejects Trump administration’s demands with federal funding at risk.

After Harvard University rejected a proposed agreement from the Trump administration outlining conditions for federal funding, federal officials said they would freeze $2.2 billion in multiyear grants along with a $60 million contract to the Cambridge, Mass.-based university. Harvard is advising its researchers to halt hiring, limit expenditures to essential needs, and pause equipment purchases due to the funding freeze. The guidance, issued by John Shaw, Harvard’s vice provost for research, emphasizes the need to prepare and protect critical research activities amid the funding disruption.

Shaw acknowledges that some research will inevitably suffer due to the freeze and calls for a responsible use of institutional resources during this challenging period.

#All

Where NIH grant cuts could hit hardest

The potential economic impact of proposed cuts to federal grants from the National Institutes of Health (NIH), specifically a cap on indirect cost payments set at 15%. This change, introduced by the Trump administration, threatens billions of dollars that support essential overhead costs for research institutions.

#All

Federal Workers Are Facing a New Reality

The problem for government employees isn’t just low morale. It’s the manufactured chaos.

#All

AHA continues to seek tariff exemptions for medical devices

AHA is actively advocating for tariff exemptions, emphasizing that the tariffs could disrupt supply chains and affect patient care. Akin Demehin, a vice president at AHA, highlights the dependency on international sources for critical supplies. Demehin notes that while hospitals may explore domestic and nearshore sourcing options, the immediate need for access to devices and PPE remains paramount.

#Device

Remote patient monitoring not always effective: report

RPM tools show varied effectiveness depending on the medical condition and the duration of monitoring. Shorter monitoring periods tend to yield better results. Traditional Medicare spending on RPM has significantly increased, from $6.8 million in 2019 to $194.5 million in 2023, with the number of patients using these services rising from 44,500 to 451,000 in the same period.

A new report calls for CMS and payers to create specific reimbursement codes for conditions that demonstrate tangible benefits from RPM. It suggests implementing duration limits and requirements for medical necessity for longer monitoring periods.

#Device, #Patient, #Provider

Death after 1 year more common for real-world low-risk TAVR patients than those treated in clinical trials

While TAVR can lead to positive results, awareness of the differences in survival rates between real-world and clinical trial populations is crucial for informed decision-making. A newly published study indicates that death after one year is more common for real-world low-risk TAVR patients than for those in clinical trials.

#Device, #Patient, #Provider

Why surgery, not TAVR, remains the best treatment for some AS patients

Transcatheter aortic valve replacement (TAVR) is starting to be used more and more to treat patients with severe aortic stenosis who are under the age of 70 and present with bicuspid aortic valves (BAVs). However, according to a new commentary published in The Annals of Thoracic Surgery, TAVR has not been proven to be the best choice for these patients, and  there are many times when surgical aortic valve replacement (SAVR) should be considered first.[1]

#Device, #Patient, #Provider

Cardiologist-founded startup announces FDA clearance, first uses of new TAVR pacing system

The startup has successfully obtained approval from the FDA for its innovative pacing system designed for TAVR procedures. The new device automates certain processes during the procedure, which helps to minimize variability and allows operators to maintain full control and leading to a reduction in workload for both physicians and staff.

#Device, #Provider, #Patient

No longer the ‘forgotten valve’: Tricuspid valve surgery outcomes keep improving

Patient outcomes after tricuspid valve replacement have improved significantly over the years, according to new data published in The Annals of Thoracic Surgery.

#Device, #Patient, #Provider

Edwards Lifesciences announces key approval for new mitral valve replacement system

Edwards Lifesciences has received CE mark approval for its Sapien M3 transcatheter mitral valve replacement system for patients with symptomatic mitral regurgitation who are not suitable candidates for surgery or transcatheter edge-to-edge repair (TEER).

#Device, #Patient, #Provider

‘Most-favored nation’ drug pricing has three significant problems

The Trump administration had proposed implementing MFN pricing, which would align U.S. drug prices with the lowest prices paid by similar countries. This policy was initially ordered for Medicare but was later blocked by the Biden administration. The article emphasizes the need for a balanced approach to drug pricing that addresses the concerns of American consumers without resorting to policies that may not yield beneficial outcomes.

#Drug

29 physician specialties ranked by pay

Annual average compensation for U.S. physicians in four medical specialties surpassed $500,000 in 2024, according to Medscape’s “Comparing Your Pay Against Your Peers’: Medscape Physician Compensation Report 2025.“

#Provider

Top Paid Specialties:

• Orthopedic and orthopedic surgery: $543,000
• Radiology: $520,000
• Plastic surgery: $516,000
• Cardiology: $506,000
• Anesthesiology: $499,000
• Gastroenterology: $495,000
• Urology: $485,000 
• Otolaryngology: $473,000
• Oncology and hematology: $452,000
• Dermatology: $424,000

Cardiologists in the United States earn an average annual income of $506,000, reflecting a 4% decrease from the previous year’s average of $525,000. In general, Physicians are seeing slower pay growth in the last year amid economic uncertainty

Specialties Taking a Haircut

• Dermatology: -11%
• Neurology: -6%
• Urology: -6%
• Plastic surgery: -4%
• Cardiology: -4%
• Ophthalmology: -4%
• Gastroenterology: -3%
• Rheumatology: -3%
• Orthopedic surgery: -3%
• Pulmonary medicine: -3%

Factors Affecting Incentive Bonuses

• RVUs generated: 59%
• Quality care metrics: 40%
• Patient satisfaction ratings: 24%
• Records completion: 23%
• Number of procedures: 20%
• Patient mix: 11%
• Payer mix: 11%
• Patient throughput time: 10%
• Cost of care reduction: 9%
• Other: 15%