Wednesday, July 15, 2026

The Centers for Medicare & Medicaid Services has released its proposed rule for the 2027 Physician Fee Schedule. The plan includes a significant structural change to shift physician pay away from the Merit-based Incentive Payment System and toward participation in accountable care organizations. CMS also proposes to recalibrate the conversion factor, which will affect payments for all fee-for-service Medicare claims. The proposal includes specific details on budget neutrality adjustments and new payment rates for evaluation and management services. The comment period is open for 60 days, with a final rule expected by November 1, 2026. Track the docket for the final conversion factor numbers and any changes to the MIPS wind-down timeline.

Experity, a major EHR and RCM vendor for urgent care and occupational medicine, has acquired Exdion Healthcare. The deal expands Experity's portfolio with Exdion's AI-powered revenue cycle automation tools. This marks a continued consolidation wave in the RCM technology space as vendors race to embed AI for coding, denial prediction, and eligibility. For practices using Experity or Exdion platforms, integration roadmaps will determine when new features become available.

CMS has proposed a rule that would expand its authority to deny or revoke Medicare enrollment under several new circumstances. The agency seeks new discretion to act based on affiliations with previously sanctioned entities, patterns of ordering unnecessary services, and failure to report changes in ownership or practice location. This follows other recent CMS proposals aimed at program integrity, signaling a more aggressive enforcement posture. The proposal is open for comment. Practices should ensure their Medicare enrollment records in PECOS are current and review any corporate affiliations that could trigger scrutiny under the new rules.

The Federal Trade Commission reached a settlement with CVS Caremark, Cigna's pharmacy benefit manager, resolving a lawsuit alleging the PBM used its market power to manipulate insulin pricing and restrict patient access to cheaper alternatives. The FTC had accused Caremark of steering patients to more expensive insulin products, raising costs for payers and patients while securing higher rebates for itself. This settlement is part of the FTC's ongoing campaign against PBM business practices it deems anticompetitive. The action underscores continued regulatory scrutiny of the PBM industry and its role in drug pricing, which affects employer-sponsored and individual market plans.

HCA Healthcare cut its 2026 earnings forecast, citing a rise in patients lacking insurance coverage as a primary factor. The for-profit hospital giant expects treating uninsured patients to trim roughly $1 billion from its projected profits this year. This signals a reversal from pandemic-era coverage gains and points to broader economic strain affecting patient ability to pay. The trend pressures hospital margins already squeezed by rising labor costs and could accelerate cost-shifting to commercially insured patients. Independent practices may see increased pressure from hospital systems seeking to recoup losses through employed-physician referrals and tightened contracting.