Read today’s Kaiser Health News
In other news:
About health insurance/insurers
Projected Savings From Reducing Low-Value Services in Medicare: Many of these services are imaging- including 4 of the top 5 low value services. Note, especially, the Figures. In summary:
Findings of this cross-sectional study highlight that reforms aimed at reducing spending for low-value services are feasible to achieve billions in savings without compromising patient health. For example, eliminating Medicare payments for 5 USPSTF grade D services could save approximately $2.6 billion annually, achievable through enforcing section 4105 of the Affordable Care Act, which grants the secretary of the US Department of Health and Human Services the authority to provide no payment for a preventive service that has not received a USPSTF grade of A, B, C, or I.
Of note, the estimated savings are considered conservative, since additional costs from subsequent care cascades following low-value interventions are not included.
Perioperative Costs of Elective Surgical Procedures in Medicare Advantage Compared With Traditional Medicare: Findings In this retrospective cohort study of 1.18 million surgical procedures among 1.11 million Medicare beneficiaries, estimated 30-day costs of surgery episodes were 3.1% lower for MA patients than for comparable TM patients. MA patients more often had outpatient surgeries, shorter inpatient hospital stays, received less postacute care, and had fewer readmissions.
Meaning The findings suggest that lower perioperative costs and resource use offer other potential mechanisms for cost savings in Medicare Advantage.
A Closer Look at the Work Requirement Provisions in the 2025 Federal Budget Reconciliation Law: Key takeaways include:
CBO estimates. Of the Medicaid provisions included in the law, CBO estimates implementing work requirements will account for the largest share of federal Medicaid savings. Earlier CBO estimates found work requirements will cause the largest increase in the number of people without health insurance.
Verification requirements. The law requires states to verify at application and at renewal that individuals in the ACA expansion group meet work requirements (80 hours of work activities per month) or exemption criteria. States can also require verification more frequently.
Implementation timeline. The law requires HHS to release an interim final rule by June 2026 leaving states with limited time to develop or change implementation plans, protocols, and systems (and to test systems changes) before the January 2027 work requirement implementation deadline.
State implementation choices. State choices to impose more stringent requirements than the minimum federal requirements outlined in the law (e.g., requiring more frequent verification or imposing longer “look-back” periods when verifying coverage) as well as state effectiveness in using existing data to automate verification processes, will affect the number of individuals at risk of losing coverage.
Comparison to other waivers and proposals. The Medicaid work requirement policies included in the law are more stringent than previous policies considered by Congress and work requirements implemented under state Medicaid demonstration waivers; for example, the law makes it harder to gain coverage and to re-enroll and does not exempt older adults from requirements
Which healthcare services are driving higher costs for insurers? FYI- the answers vary somewhat by payer.
Payers ranked by Q2 profits FYI
16 health system rating downgrades FYI
About hospitals and healthcare systems
CMS finalizes 2.6% pay bump for hospitals in 2026: 8 things to know CMS published its fiscal year 2026 Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System final rule on July 31.
This article is an excellent, short summary of changes from the legislations.
Online Reviews of Health Care Facilities: Question What words, linguistic categories, and themes correlate with highly positive or negative ratings in online reviews of health care?
Findings In this cross-sectional study of 1 099 901 online reviews posted from 2017 through 2023, 46.3% of US health care facilities were rated 1 to 2 stars and 50.1% were rated 4 to 5 stars. The word “not” and topics related to administrative barriers were significantly associated with negative ratings, whereas the conjunction “and” and words related to support staff interactions were associated with positive ratings.
Meaning Findings of this study suggest that assessing online-review language in real time could help clinicians and administrators identify possible emerging communication or access problems and target patient-centered quality-improvement interventions.
Variations in the Use of Outpatient Surgery: Findings In this cross-sectional study of 456 954 participants, variations in the use of outpatient surgery were associated primarily with geographic location. Lower frequency of outpatient surgery at hospitals in the Northeast and Pacific Coastal regions was not explained by patient- or hospital-related factors.
Meaning Recognition of geographical variations and providing benchmarking national data may improve use of resources for patients undergoing surgery.
Comment: Non-health reasons for utilization differences have been recognized for decades.
About the public’s health
AMA decries CDC's move to cut experts out of panels that develop vaccine policy: Eight medical associations, including the American Medical Association, American Academy of Pediatrics and the Infectious Diseases Society of American, are "alarmed" that the federal immunization adviser is barring them from looking at scientific evidence that is supposed to inform its decision-making process.
The U.S. Centers for Disease Control & Prevention told physician groups, public health professionals and infectious disease experts that they will no longer be invited to help review vaccine data and develop recommendations, according to an email viewed by Bloomberg.
State E-Cigarette Flavor Restrictions and Tobacco Product Use in Youths and Adults: Question Are statewide e-cigarette flavor restriction policies associated with e-cigarette and cigarette use among different age groups?
Findings In this cross-sectional study of 2019-2023 survey data on US high school-aged youths, young adults (ages 18-24 years), and adults ages 25 years or older, flavor policies were associated with reduced e-cigarette use among young adults and adults aged 25 years or older and increased cigarette use among youths and young adults, although results varied by state and year.
Trump revives Presidential Fitness Test: President Donald Trump signed an executive order Thursday afternoon reinstating the national fitness assessment implemented in public schools from 1956 until 2013.
The role of administering the test will fall to Health and Human Services Secretary Robert F. Kennedy Jr….
A White House official told NBC News that Trump aims to address Americans’ declining health and physical fitness, including “crisis levels” of obesity, chronic disease, inactivity and poor nutrition.
About healthcare IT
Physician satisfaction with EHRs, by the numbers: Physicians are most satisfied with EHR reliability but least pleased with the systems’ efficiency, KLAS Research reported.
Healthcare data breaches remain the costliest: 5 notes: Healthcare had the most expensive data breaches for the 15th consecutive year, according to a new IBM report.