Site-Neutral Payments Still a Long Ways Off

Posted on November 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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An October 2025 Health Affairs study found that payment equity between facilities owned by hospitals, known as hospital outpatient departments (HOPDs), and independent outpatient facilities such as ambulatory surgery centers (ASCs), is still far from reality. Comparing payments for common procedures, researchers found commercial prices were 78% higher in HOPDs compared to ASCs, although payment differentials varied considerably.

This Health Capital Topics article reviews the article and potential policy implications. (Read more…) 

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HEALTH CARE SPENDING: Projected to Exceed $8.5 Trillion by 2033

Posted on July 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants LLC

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On June 25th, 2025, the Centers for Medicare & Medicaid Services (CMS) released its forecast on U.S. healthcare spending through 2033. The analysis, published in Health Affairs, estimated healthcare spending growth in 2024 and projected the growth into 2033. CMS found that overall healthcare spending growth has decreased slightly but is still elevated compared to pre-pandemic levels, and is expected to continue to moderately grow.

This Health Capital Topics article examines the factors underlying the forecasts. (Read more…) 

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“BIG BEAUTIFUL BILL”: Not So for Healthcare?

Posted on June 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants; LLC

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On May 22, 2025, the U.S. House of Representatives moved President Trump’s budget proposal forward, sending to the Senate a budget reconciliation bill (with a one-vote margin) – the One Big Beautiful Bill Act of 2025 – that renews expiring tax cuts and enacts new ones at a cost of almost $4 trillion. These costs would largely be paid for by cuts to other programs, including to federal healthcare programs, which cuts will have significant ramifications for the healthcare industry.

This Health Capital Topics article reviews the current status of the budget bill and healthcare industry implications. (Read more…)

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MEDICARE: Four Payment Models Ended Early

Posted on March 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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Four Medicare Payment Models Ended Early

In the latest iteration of Trump Administration healthcare cuts, the Centers for Medicare & Medicaid Services (CMS) announced on March 12th, 2025 that four Center for Medicare and Medicaid Innovation (CMMI) payment models would be sunset at the end of 2025, earlier than originally scheduled.

Cutting these models, which decision was based on “a comprehensive and data-driven review of [CMS’s] model portfolio,” are anticipated to save nearly $750 million (although the source of these savings was not detailed).

This Health Capital Topics article discusses the models being ended and the impact on healthcare stakeholders. (Read more…)

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TRUMP ADMINISTRATION: Day-One Healthcare Moves

Posted on January 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

In the first days of his second (nonconsecutive) presidential term, Donald Trump and his administration took a number of actions that will affect the healthcare industry in the near- and long-term. Further, the Trump Administration is reportedly poised to take a number of additional actions to pause, end, or otherwise change Biden-era initiatives.

Meanwhile, President Trump’s cabinet pick for the Department of Health & Human Services (HHS) hangs in the balance. This Health Capital Topics article reviews the new administration’s actions impacting the healthcare industry as of the date of publication. (Read more...)

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OPPS: Final Rule Issued by CMS

Posted on December 6, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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On November 1, 2024, CMS released its Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule for calendar year 2025. The rule finalizes payment updates, revises current programs, and establishes new standards to address the ongoing maternal health crisis.

This Health Capital Topics article discusses the key OPPS changes and updates included in the Final Rule. (Read more…)

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MPFS Final Rule Cuts Physician Payments [Will it Last?]

Posted on December 4, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released its finalized Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2025, aiming “to strengthen primary care, expand access to preventive services, and further access to whole-person care.” While the finalized fee schedule cuts payments to physicians, Congress is considering legislation to override the cut.

This Health Capital Topics article discusses the provisions contained in the MPFS final rule, as well as the proposed “doc fix” legislation. (Read more…)

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MPFS Final Rule Cuts Physician Payments

Posted on December 2, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Medicare Physician Fee Schedule

By Health Capital Consultants

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DEFINITION: The Centers for Medicare and Medicaid Services (CMS) uses the Medicare Physician Fee Schedule (MPFS) to reimburse physician services. The MPFS is funded by Part B and is composed of resource costs associated with physician work, practice expense and professional liability insurance.

Under the MPFS, each of these three elements is assigned a Relative Value Unit (RVU) for each Current Procedural Terminology (CPT®) code. These RVUs are then adjusted based on the Geographical Practice Cost Index associated with various geographic areas for different medical costs and wage differentials. The conversion factor is the national dollar amount that is multiplied by the total geographically adjusted RVU to determine the Medicare-allowed payment amount for a particular physician service.

CITE: https://www.r2library.com/Resource

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MPFS Final Rule Cuts Physician Payments

On November 2nd, 2023, the Centers for Medicare & Medicaid Services (CMS) released its finalized Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2024. While the finalized fee schedule cuts payments to physicians, there are a number of other (more positive) provisions in the final rule.

This Health Capital Topics article explores the various changes and updates included in the MPFS final rule. (Read more…)

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HOSPITALS: Price Discrepancies Exposed!

Posted on October 3, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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On September 18, 2023, the Journal of the American Medical Association (JAMA) published a study comparing online hospital pricing and pricing given over the telephone for shoppable hospital services. Hospitals in the U.S. are required to post pricing online for specified services, but it was unknown whether or not hospitals quoted the same prices to telephone callers as they posted online.

This Health Capital Topics article will discuss the topic of price discrepancy and the difficulties with cost comparison. (Read more…) 

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Letters to Trump – Continue Focus on Value-Based Payment

Posted on April 12, 2017 by Dr. David Edward Marcinko MBA MEd CMP™

Two Letters to Trump from Healthcare Leaders – Continue Focus on Value-Based Payment

By Robert James Cimasi MHA CMP™

Health Capital Consultants, Inc

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In December 2016 and January 2017, over 100 leading healthcare organizations sent two letters to President Donald Trump and Vice President Michael Pence lobbying the Trump Administration to continue the shift in healthcare reimbursement from volume-based to value-based payment models.
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The expansion of the number and scope of value-based reimbursement programs following the 2010 passage of the Patient Protection and Affordable Care Act (ACA) is in keeping with the national strategy regarding healthcare reimbursement in the landmark legislation; most notably the fourth priority established by the ACA, i.e., to “…improve Federal payment policy to emphasize quality and efficiency…“
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However, in light of the criticism of many in the Trump Administration regarding value-based reimbursement models, most notably Tom Price, M.D., the Secretary of the U.S. Department of Health and Human Services (HHS), many healthcare delivery organizations felt compelled to advocate for continued implementation of such payment systems, and acted by sending the above referred letters to the new administration.
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This Health Capital Topics article summarizes the contents of those two letters received by the Trump Administration, and discusses how this advocacy fits into the current uncertainty surrounding healthcare reform. (Read more…) 

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