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doctors
Medicare cuts pay for surgeries
In a blow to specialists, Medicare on Friday made good on its earlier proposal to cut payments for surgeries, outpatient procedures, and other services it believes can be done more efficiently, Tara Bannow reports.
The policy is both controversial and easy to miss, due to its technical nature, but Tara knows her stuff.
The policy involves a so-called efficiency adjustment, which assumes that advances in technology and standardized workflows reduce the time and expense of performing certain procedures. Medicare will cut pay rates 2.5% for those services starting Jan. 1.
Meanwhile, payments for time-based services that primary care doctors typically provide, such as office visits or behavioral health therapy, will not be cut. Telehealth and certain maternity services will also be unaffected.
Read more.
UnitedHealth Group pays its own physician practices much more than it pays competing practices
By Tara Bannow
Nov. 3, 2025
Hospitals and Insurance Reporter
UnitedHealth Group pays its own physician practices much more than it pays competing practices, a new study finds, reinforcing STAT’s own analysis on the subject and presenting fresh evidence that the conglomerate may be skirting a rule designed to curb health insurer profits.
UnitedHealth’s insurance arm, UnitedHealthcare, pays practices under its UnitedHealth-owned Optum umbrella 17% more on average for common services than it pays non-Optum practices in the same region, according to the study, published today in Health Affairs. In areas where its insurance arm has a large market share, it pays Optum practices 61% more.
from Politico:
DOC PAY — Physicians are scrambling to dissect the implications of a 2,300-page rule the Centers for Medicare and Medicaid Services released on Halloween night, which sets how Medicare will pay doctors. Finalized Friday, the rule spells varied fates for doctors across disciplines. For example, allergists netted a 7 percent increase, but neurosurgeons will take a 5 percent cut. General practitioners — a focus of Health Secretary Robert F. Kennedy Jr.’s Make America Healthy Again agenda to combat chronic disease — will get a 3 percent bump in pay. Doctors have good reasons to celebrate: CMS skipped its annual cut to Medicare reimbursements, offering a reprieve in 2026. While it’s not a permanent fix, it spares doctors another year of payment reductions. The rule also streamlines and expands telehealth, lifting visit-frequency limits for certain virtual services. But the rule breaks with the American Medical Association, whose advisory committee has for decades recommended Medicare payments. That committee has long been criticized for favoring specialties over primary care. CMS called the group out for what it said were “overinflated” valuations. The rule docks pay for most procedures by 2.5 percent, undercutting the AMA recommendations, arguing the treatments have become more efficient over time. But the rule goes several steps further, suggesting alternatives to the AMA in making these determinations. CMS also declined to use a key AMA survey to calculate practice expenses, citing “low response rates” and other errors. The AMA has stood by the accuracy of its data. CMS said it hopes to use hospital data instead. Their new calculation recognizes higher costs for providers not part of larger health facilities at the expense of many specialists associated with hospitals. “This rule will make it harder for independent practices to remain viable parts of our health system,” AMA President Bobby Mukkamala said in a Monday news release. |
