US CMS healthcare payment and cost-reduction initiatives

The Centers for Medicare and Medicaid Services (CMS) has introduced new initiatives to improve healthcare delivery and reduce costs. This includes the Learning Insights for Action (LIA) project, a four-year contract with Mathematica and Deloitte intended to scale effective payment and service delivery models through data-driven evidence.

To address Medicare spending, CMS proposed changes to the Outpatient Prospective Payment System (OPPS) rule. These measures aim to mitigate price distortions by expanding site-neutral payments for certain imaging services and narrowing the inpatient-only list to prevent higher rates for services based solely on location.

In response, healthcare organizations have urged CMS to revise the proposed 2027 payment rules for hospital outpatient systems and ambulatory surgical centers (ASCs). The Ambulatory Surgery Center Association (ASCA) warned that projected reimbursement reductions for frequently performed procedures could limit access to low-cost care. Concurrently, the Healthcare Financial Management Association (HFMA) raised concerns regarding payment adequacy, site-neutral accuracy, and the potential for financial and operational disruption to provider capacity.