Delving into aspects of recent CMS Medicare rules,

• Healthcare Dive reports,
  • “The CMS is proposing to overhaul the Medicare Advantage star ratings system, including by culling a dozen quality measures and removing a health equity reward. 
  • “In a proposed rule released Tuesday, the agency said it wanted to cut 12 metrics that focus on administrative processes where health plan performance is typically high and beneficiaries can’t easily distinguish between offerings, like customer service and appeal timeliness. Most of the cuts would go into effect in the 2029 star ratings. 
  • “The CMS is also proposing to not implement the Excellent Health Outcomes for All reward, designed to incentivize plans to improve care for enrollees who are low-income or disabled. Additionally, the agency wants to add a quality measure on depression screening and follow-up.”

• Modern Healthcare tells us,
  • “A new Medicare policy on complex surgical procedures could drive a deluge of patients to outpatient facilities. But while some view the change as a win for beneficiaries and taxpayers, others see clinical risks.
  • “The Centers for Medicare and Medicaid Services will phase out the Medicare Inpatient-Only List over the next three years under the Hospital Outpatient Prospective Payment System final rule for 2026, which it published Friday. The first stage is allowing outpatient providers to bill for 285 musculoskeletal codes that currently are only reimbursable for inpatient hospitals.
  • “The Ambulatory Surgery Center Association welcomed the relaxed rules. “The elimination of the Inpatient-Only List provides Medicare beneficiaries the ability to work with their surgeon to best determine the appropriate site of care,” Chief Advocacy Officer Kara Newbury wrote in an email.
  • Similarly, the Medical Group Management Association believes this policy will enhance access and reduce costs, said Senior Vice President of Government Affairs Anders Gilberg.
  • Yet the American Hospital Association stands firmly against ending the Inpatient-Only List. “The AHA opposes CMS’ proposal to eliminate the [Inpatient-Only List] over three years. Instead, the AHA recommends that CMS continue with its standard process for removing procedures from the [Inpatient-Only List],” Ashley Thompson, senior vice president of public policy analysis and development, wrote CMS on Sept. 15.
  • “We are concerned that, given the depth and breadth of the 1,731 procedures on the [Inpatient-Only List], it would be reckless to eliminate them all,” Thompson wrote. “We are concerned that CMS is proposing a blanket policy to essentially remove all procedures without an examination of any safety or other implications.”

• MedTech Dive informs us,
  • “The Centers for Medicare and Medicaid Services has finalized a payment policy that covers cardiac catheter ablation procedures in ambulatory surgery centers for the first time.
  • “The Heart Rhythm Society’s advocacy arm representing electrophysiologists called the final rule, which is effective Jan. 1, 2026, a milestone for the field. “This change expands Medicare beneficiary access to EP services and represents one of the most significant federal advancements in how and where EP care is delivered in more than two decades,” the group said. 
  • “Wall Street analysts said the new ASC reimbursement payment could boost atrial fibrillation procedure volumes, potentially benefiting Abbott, Boston Scientific, Johnson & Johnson and Medtronic.”

From the public health and medical / Rx research front,

• The Washington Post lets us know “Ozempic 2.0 is on the way, and it could be even more transformative. A new weight loss pill could come within months, and other experimental treatments with more potency are not far behind.”
  • “A new wave of the medicine is coming that could be even more transformative for human health: pills, more potent injectables and new compounds that might have fewer side effects or could be taken just once a month.
  • “With this newer generation of medications, we’re not just focusing on weight loss,” said David Lau, an endocrinologist and professor emeritus at the University of Calgary Cumming School of Medicine. “We’re talking about changes beyond what you see on the scale.”

• NBC News relates,
  • “As we age, the human brain rewires itself. 
  • “The process happens in distinct phases, or “epochs,” according to new research, as the structure of our neural networks changes and our brains reconfigure how we think and process information.
  • “For the first time, scientists say they’ve identified four distinct turning points between those phases in an average brain: at ages 9, 32, 66 and 83. During each epoch between those years, our brains show markedly different characteristics in brain architecture, they say.
  • “The findings, published Tuesday in the journal Nature Communications, suggest that human cognition does not simply increase with age until a peak, then decline. In fact, the phase from ages 9 to 32 is the only time in life when our neural networks are becoming increasingly efficient, according to the research.”

• Cancer Advisor points out,
  • “Overweight and obesity are both associated with a greater risk of developing pancreatic cancer by the age of 50 years, according to research published in the European Journal of Cancer.
  • “These findings indicate that even modest excess weight in early adulthood, including overweight and mild obesity, may represent an independent and modifiable risk factor for young-onset pancreatic cancer,” study researchers wrote.
  • “Although the incidence of pancreatic cancer among adults under the age of 50 years has risen in recent years, the risk factors driving young-onset pancreatic are not well defined, the researchers noted. In this study, they evaluated the dose-response relationship between body mass index (BMI) and the risk of developing pancreatic cancer by the age of 50 years.”

• Per Medscape, “Chronic Gut Pain’s Elusive Cause Found — and Possibly Fixed.”

From the U.S. healthcare business front,

• Modern Healthcare reports,
  • “Health insurance mergers and acquisitions picked up in the third quarter as companies seek to gain scale, modernize operations and stay competitive in a difficult regulatory and cost environment. 
  • “Insurers announced 10 M&A deals during the third quarter, up from seven in the year-ago period, according to data compiled by the Levin Associates, and more have emerged during the fourth quarter.
  • “This month, MVP Health Care and Independent Health announced a deal, Medica proposed buying UCare’s exchange and Medicaid operations, and Cambia Health Solutions and Arkansas Blue and Cross and Blue Shield inked an agreement to affiliate.
  • “It definitely seems to have a new momentum behind it. Payers are definitely more active,” said Dan Farrell, a partner and health services deals leader at the consulting firm PricewaterhouseCoopers. “It’s accelerating at all levels, and I think that will continue through the end of 2025 and into the first half of ‘26.” 

• McKinsey & Company evaluates the “Future of US healthcare: Gathering storm 2.0 or a golden age?”
  • “Health industry economics continue to be roiled in the postpandemic era, and the outlook for funding suggests continuing relentless pressure. Healthcare industry EBITDA as a proportion of national health expenditure (NHE) was 200 basis points lower in 2024 compared with 2019. From 2024 through 2027, it is expected to fall another 100 basis points, with marginal recovery expected by 2028 through targeted interventions, according to McKinsey research.
  • “Nonetheless, the potential opportunity from advances in AI, automation, efficient sites of care, medical science, and care model innovation is staggering. We estimate that the available improvement opportunity is 9 to 15 percent of NHE on a run-rate basis.¹
  • “As always, the opportunity to improve healthcare outweighs the headwinds if healthcare leaders can unlock the transformation required to seize the opportunity.”

• Fierce Healthcare informs us,
  • “Three drugs treating chronic conditions are set for Food and Drug Administration review by the end of the year, and a new report from Optum Rx digs into why payers should be watching these decisions.
  • “According to the report, the FDA is set to review an oral formulation of Novo Nordisk’s GLP-1 Wegovy as well as depemokimab, a drug that treats eosinophilic asthma, and remibrutinib, a therapy for chronic spontaneous urticaria under the brand name Rhapsido.
  • “Sara Guidry, senior director of pipeline and drug surveillance at Optum Rx, told Fierce Healthcare in an interview that these drugs target weight and chronic inflammatory conditions, both segments that are significant cost drivers for payers and plan sponsors.
  • “They are two topics we are consistently discussing with payers and clients,” Guidry said.”
• and
  • “WellTheory, a virtual platform for autoimmune care, is partnering with Instacart to embed grocery stipends into its care model. The partnership addresses a critical gap in autoimmune care: access to nutritious, anti-inflammatory foods, according to the companies.
  • “By integrating Instacart’s Health Fresh Funds, more than 300,000 eligible WellTheory members can purchase clinically recommended groceries to support healthier nutrition decisions.
  • “Autoimmune patients often face significant barriers to accessing the right foods — from affordability and availability to the daily friction of turning dietary guidance into actionable shopping decisions. The new Instacart partnership supports WellTheory’s mission to fill the gaps left behind by traditional healthcare and provide whole-person care that addresses the root causes of autoimmunity, executives said.
  • “Instacart reaches more than 98% of U.S. households, including 95% of those located in food deserts and nearly 98% of households enrolled in SNAP, the grocery technology company said.”