CMS seeks input on alternatives to CPT
CMS is seeking public input on alternatives to the physician payment system that relies on AMA-owned CPT codes and recommendations from the AMA’s Relative Value Scale Update Committee. CMS noted longstanding concerns about relying on a private organization whose recommendations inform physician payment and cited criticism that the current process may overvalue procedural services relative to primary care. The agency is requesting comments by Sept. 14, 2026, on potential conflicts of interest, CPT licensing costs, and alternative approaches for developing payment recommendations and valuing physician services. (MedPage Today; JD Supra)
HCA: Former ACA enrollees becoming uninsured
HCA Healthcare affirmed its earlier warnings about Affordable Care Act (ACA) exchange subsidies fallout. During a recent investor call, CEO Sam Hazen said the company’s general estimates around how many patients would drop marketplace coverage were generally accurate: Adjusted admissions among these patients fell 15% during each of the year’s first two quarters. “We expected some of these patients to shift to other forms of coverage, but this did not happen,” he said. “Instead, these patients migrated almost one for one to uninsured,” as opposed to the 80% to 85% the company had expected. (Fierce Healthcare)
Practice Transformation
Medicare drug subsidies on chopping block
The Trump administration recently announced plans to end a Biden-era program that for the past two years has helped tamp down the cost of monthly premiums for drug coverage for people on Medicare. Millions of Americans 65 and older could face higher Medicare drug premiums next year. CMS Administrator Dr. Mehmet Oz says premiums will go up by less than $10 for most Medicare recipients. But it is not clear yet how many people may have to pay more, and how much it will cost them, the New York Times reports. (New York Times)
Family physician continuity linked to lower mortality
Research continues to demonstrate that continuity of primary care improves health outcomes. For example, a Norwegian study found that patients who remained with the same family physician for 15 years had lower rates of emergency department visits, hospitalizations, and mortality than those with shorter physician relationships. The findings build on multiple previous studies and systematic reviews linking continuity of care with better outcomes, lower healthcare utilization, and lower costs. Experts say the growing body of evidence supports policies that strengthen long-term patient-physician relationships despite increasing fragmentation of primary care. (Medscape)
Evidence & Innovation
Safety report cites counterfeit drugs, AI governance and workforce risks
A pharmacy-focused review of ECRI and the Institute for Safe Medication Practices’ Top 10 Patient Safety Concerns for 2025 identifies counterfeit and substandard drugs as its top patient safety concern, citing growing risks from increasingly sophisticated counterfeit products and vulnerabilities in the pharmaceutical supply chain. The report also calls for stronger governance of AI in healthcare, improved strategies to reduce diagnostic errors in cancer, and greater attention to clinician burnout and workplace violence. It emphasizes pharmacists’ role in medication safety, technology oversight and interdisciplinary collaboration. (Pharmacy Practice News)
Policy Solutions
Study raises questions about use of lower-cost off-label therapies
New research is renewing discussions about whether lower-cost medications should be used more widely when they produce outcomes comparable to newer, more expensive alternatives. An international study found that off-label use of rituximab was as effective as ocrelizumab (Ocrevus) in preventing relapses and slowing disability progression in patients with relapsing multiple sclerosis. The findings add to growing evidence supporting value-based prescribing and could influence future treatment decisions, healthcare spending and access to care. (MedPage Today)
