Last week’s federal court ruling in favor Clover Health (CLOV) against CMS injects fresh uncertainty into the Medicare Advantage (MA) Star Ratings and quality bonus payment framework [UNH, HUM, ELV, CVS, ALHC, CNC, MOH]. While…

The House and Senate are both in session this week, but the market-relevant question is less about what Congress does over the next couple of weeks and more about how much time Republicans waste before…

This morning’s final rule revising operations of the No Surprises Act (NSA) federal independent dispute resolution (IDR) process does not seem to upset the balance that has favored certain out-of-network specialist physicians and hospitals [NUTX,…

With Noridian (17% of services) including instructions that physicians bill for Inspire Medical’s (INSP) Inspire V procedure with a -52 (reduced work / payment) modifier this morning, following a similar update from WPS on May…

We wanted to give you and update on two bills in the California legislature, impacting META, GOOGL, SNAP, STUB, and LYV, that we have been following and which we expect to be considered on the…

Following last week’s draft LCDs requiring Glaukos (GKOS) iDose patients to first fail ≥ 2 topical medications and selective laser trabeculoplasty (SLT), the absence of reliable data on the proportion of existing patients that can…

CMS’s long-awaited proposed rule implementing the One Big Beautiful Bill’s (OBBB) restrictions on state directed payment programs (DPPs) pushes the envelope a bit further than the statute itself, particularly for hospitals [HCA, THC, CYH, UHS,…

The draft local coverage decision (LCD) issued today by five MACs with jurisdiction over ~70% of Glaukos (GKOS) Medicare FFS volumes is both better and worse than we had anticipated for the company’s growing iDose…

We expect AB 1720, the California Fans First Act, which would prohibit a ticket reseller (STUB, LYV) from selling or facilitating the sale of a covered ticket for more than the original price plus 10%,…

Two long-anticipated hospital-specific Medicaid state directed payment programs (DPPs) in Florida and Indiana, benefitting HCA, CYH, and THC and other hospitals in those states, appear to have been approved by CMS in recent weeks, according…

With the Trump/Xi summit having concluded with little fanfare, though that was mostly expected, the House and Senate are in session for one final week before a week-long Memorial Day recess. The top item in…

With today’s rejection of INSP’s coding application for the Inspire V device by the AMA, the company’s last opportunity to have a new code take effect by Jan. 1, 2028 will be to secure approval…

Key Takeaways We expect Congress to pass a short-term extension of the highway bill, potentially before the Sept. 30, 2026, deadline, likely at current funding levels plus an inflation adjustment. Multiple short-term extensions could follow…

Below are the key takeaways from our conference call on this week’s Trump/Xi summit in Beijing. During the call, we touched on trade in general as well as the USMCA agreement. Our base case remains…

CMS’s announcement of a six-month moratorium on new hospice and home health agency enrollment in Medicare is the latest escalation in the administration’s broader crackdown on alleged waste fraud, and abuse, reinforcing its ongoing targeting…