National Daily Hospital Executive Briefing Wednesday November 5th, 2025

 National Daily Hospital Executive Briefing — November 05, 2025

Focus: CMS CY 2026 PFS Final Rule (incl. MSSP updates) + OPPS outlook

Global & Health Sector Headlines (U.S.)

1. CMS finalizes CY 2026 Physician Fee Schedule (effective Jan 1, 2026) with policy changes across Part B; see fact sheet for details on payment updates, coverage, and quality policies. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f

Health Policy & Industry Updates (U.S.)

1. MSSP ACO changes finalized in the CY 2026 PFS—CMS summarizes benchmarking/patient attribution updates and other program refinements. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f-medicare-shared-savings

2. AHA notes release of CY 2026 PFS final rule and highlights key implications for hospitals/clinicians. https://www.aha.org/news/headline/2025-10-31-cms-issues-cy-2026-physician-fee-schedule-final-rule

3. OPPS/ASC CY 2026 remains at proposed stage (2.4% update factor)—monitor for final rule; see CMS page/Federal Register. https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-and-ambulatory-surgical

https://www.federalregister.gov/documents/2025/07/17/2025-13360/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical

4. CMS price-transparency enforcement resources updated; use CMS enforcement list and enforcement data hub to check penalties/status. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions and https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-price-transparency-enforcement-activities-and-outcomes

5. California SB 525: State FAQ clarifies salary thresholds and interaction with statewide minimum wage; confirm local implementation for system HR/finance planning. https://www.dir.ca.gov/dlse/Health-Care-Worker-Minimum-Wage-FAQ.htm

Early Morning Briefing Highlights

1. New: CMS PFS final rule posted Oct 31, 2025—review specialty impacts, telehealth/behavioral updates, and MSSP changes; flag revenue-neutral shifts at the service-line level. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f

Strategic Implications for Leadership

1. Budget & comp planning: model CY 2026 PFS rates by service line; revisit call coverage, APP models, and value-based incentives tied to MSSP KPIs. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f-medicare-shared-savings

2. Outpatient growth: track OPPS finalization; stress test ASC vs HOPD site-of-service margins using the proposed 2.4% update as a base case. https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-and-ambulatory-surgical

3. Transparency readiness: verify machine-readable file completeness and shoppable services display; compare peers using CMS enforcement datasets. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions

Quality Metrics to Share with Your Team (≤7)

1. PFS final rule publication date: October 31, 2025 (anchor for policy effective Jan 1, 2026). https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f

2. MSSP ACO policy update summary available from CMS (use for KPI mapping). https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f-medicare-shared-savings

3. OPPS/ASC CY 2026 proposed update factor: 2.4% (monitor for final). https://www.federalregister.gov/documents/2025/07/17/2025-13360/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical

4. Hospital Price Transparency enforcement dataset (use to benchmark state-level enforcement activity). https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-price-transparency-enforcement-activities-and-outcomes

5. California HCW minimum wage FAQ updated June 2025 (reference for HR/pay band planning). https://www.dir.ca.gov/dlse/Health-Care-Worker-Minimum-Wage-FAQ.htm

Leadership Call to Action (≤5)

1. Assign finance + service-line dyads to run CY 2026 PFS impact models (baseline + sensitivity) and brief ELT this week. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f

2. Have ACO leadership map MSSP changes to contracts, quality dashboards, and attribution analytics; prepare provider education. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f-medicare-shared-savings

3. Confirm price transparency compliance (machine-readable + shoppable) and remediate any gaps identified vs. CMS enforcement patterns. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions

4. Track OPPS/ASC rule finalization; update outpatient/ASC capital plans and payer negotiations assumptions accordingly. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient

5. For California operators, re-validate SB 525 pay bands and salary thresholds vs. DIR FAQ; ensure budgeting and HRIS alignment. https://www.dir.ca.gov/dlse/Health-Care-Worker-Minimum-Wage-FAQ.htm

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