National Daily Hospital News — Executive Briefing
Date: November 03, 2025 (Monday)
Global & Health Sector Headlines
Hospital price transparency enforcement steps escalate under 2025 executive order and updated CMS guidance—expect tougher audits and standardized machine‑readable files with dollar-encoded amounts. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency
Updated CMS guidance (May 22, 2025) details encoding of allowed amounts in machine‑readable files, aligning with the 2025 Executive Order. https://www.cms.gov/files/document/updated-hpt-guidance-encoding-allowed-amounts.pdf
Analysis highlights that transparency alone won’t lower costs without usable data and stronger enforcement—implications for hospital compliance teams. https://www.reuters.com/business/healthcare-pharmaceuticals/trump-healthcare-price-transparency-order-may-not-bring-intended-relief-patients-2025-03-27/
Health Policy & Industry Updates
CMS issues CY 2026 Physician Fee Schedule (PFS) Final Rule (CMS‑1832‑F) with policy updates effective January 1, 2026. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f
CMS fact sheet on PFS changes to Medicare Shared Savings Program (MSSP) outlines participation and operations updates. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f-medicare-shared-savings
CMS press release notes a -2.5% efficiency adjustment to select services in CY 2026 PFS to reflect productivity gains. https://www.cms.gov/newsroom/press-releases/cms-modernizes-payment-accuracy-significantly-cuts-spending-waste
OPPS/ASC CY 2026 rulemaking continues—proposed rule on display; monitor for final rate‑setting and Mo‑99 domestic production add‑on effective 2026. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient
Early Morning Briefing Highlights
PFS Final Rule (CY 2026) published 10/31/2025; begin modeling 2026 RVU impacts and practice expense assumptions now. https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1832-f
Transparency: ensure machine‑readable files use CMS template and include estimated allowed dollar amounts when required. https://www.cms.gov/files/document/updated-hpt-guidance-encoding-allowed-amounts.pdf
California SB 525: continue phasing wage schedules; confirm coverage and thresholds using state FAQ. https://www.dir.ca.gov/dlse/Health-Care-Worker-Minimum-Wage-FAQ.htm
Strategic Implications for Leadership
Recalculate 2026 service line margins incorporating the -2.5% efficiency adjustment exposure for affected CPT/HCPCS groups; update payer strategy where site‑of‑service shifts are likely. https://www.cms.gov/newsroom/press-releases/cms-modernizes-payment-accuracy-significantly-cuts-spending-waste
Tighten price transparency operations—standardize MRF pipelines, validate payer‑specific allowed amounts, and implement monthly QC to reduce enforcement risk. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency
In California, stress‑test labor budgets across SB 525 wage tiers and exempt‑salary thresholds to avoid compression and misclassification issues. https://www.dir.ca.gov/dlse/Health-Care-Worker-Minimum-Wage-FAQ.htm
Prepare MSSP participation and quality reporting updates aligned with PFS‑linked policy tweaks; coordinate ACO governance and data sharing. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f-medicare-shared-savings
Case Studies
New Case Study — NYC Office of Healthcare Accountability gains access to payer data (Anthem) to target high‑price outliers, illustrating how integrated datasets can drive municipal purchasing leverage. https://nypost.com/2025/03/29/us-news/anthem-blue-cross-agrees-to-help-nyc-crack-down-on-soaring-health-care-costs/
Case Study as Shared Previously — National transparency compliance trends show uneven adherence, underscoring need for internal audits and consumer‑facing clarity. https://www.axios.com/2024/11/20/hospital-price-transparency-dips-report
Quality Metrics to Share with Your Team (≤7)
PFS CY 2026 effective date: January 1, 2026 (policy go‑live for updated RVUs, GPCIs, and related provisions). https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f
Efficiency adjustment magnitude: -2.5% on select services finalized in PFS CY 2026. https://www.cms.gov/newsroom/press-releases/cms-modernizes-payment-accuracy-significantly-cuts-spending-waste
Price transparency MRF requirements: CMS template mandatory (from July 1, 2024) and dollar‑encoded amounts required (from Jan 1, 2025). https://www.cms.gov/files/document/updated-hpt-guidance-encoding-allowed-amounts.pdf
OPPS/ASC 2026: Proposed updates pending finalization; monitor for finalized outpatient rate updates and special add‑ons (e.g., Mo‑99) for 2026. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient
California SB 525: health care worker minimum wage schedules phased by facility type—verify tier and salary thresholds. https://www.dir.ca.gov/dlse/Health-Care-Worker-Minimum-Wage-FAQ.htm
Leadership Call to Action (≤5)
Assign a cross‑functional team to complete a 2026 PFS impact model by service line within two weeks and brief the finance committee. https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1832-f
Stand up a monthly audit of price transparency files (MRF and shoppable services) with automated checks for required fields and valid URLs. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency
In CA, update compensation grids and budgets for SB 525 compliance, ensuring exempt salary thresholds meet the higher statewide‑based standard. https://www.dir.ca.gov/dlse/Health-Care-Worker-Minimum-Wage-FAQ.htm
Prepare governance and data‑sharing updates for ACO/MSSP participation based on CY 2026 PFS rule details. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f-medicare-shared-savings
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