CMS’s release of its preliminary PAMA rate determinations earlier this week for lab services without private payer data implies a 14.9% reduction in ABT’s [EXAS] Cologuard Plus payments next year, taking the Medicare FFS rate…

Below are our thoughts on this afternoon’s HHS release of the National Kidney Dialysis Plan [DVA, FRE.DE, private US Renal, Innovative Renal Care]: The stock reaction [DVA, FRE.DE] seems overblown, especially given the limited near-term…

There are some reasons to believe the Republicans could perform better than current polling suggests, despite the fact that the political environment remains difficult for the GOP, with President Trump’s overall approval rating at just…

Questions remain about potential CY28 policy pressures on Medicare Advantage (MA) insurers [HUM, ALHC, CLOV, UNH, CVS, ELV, CNC, MOH] and value-based care providers [AGL, ASTH, PRVA, EVH, private Aledade], particularly Star Ratings, risk adjustment,…

Recent developments are raising the risk of future changes to the No Surprises Act, with implications for specialty physicians and hospitals [NUTX, private TeamHealth, Radiology Partners, SCP Health] and commercial insurers [UNH, CI, ELV, CVS]….

Yesterday’s publication of DXCM’s full non-insulin treated (NIT) Type 2 diabetes CONNECT study in NEJM is likely the last puzzle piece needed for the DME MACs to move forward with an expanded Medicare coverage proposal,…

After yesterday’s earnings report for ASML (ASML), we wanted to update investors on the MATCH Act, which is being debated in Congress and would likely have a material impact on the company if passed. We…

We continue to believe there is an 85% chance Democrats win control of the House and a 60% chance they also take the Senate in November. Given Democratic control of the House is very likely…

A proposal by Senator Ruben Gallego (D-AZ) this week likely gives investors an idea of what’s in store for the AI / data center complex if Democrats take control of Congress next month (our base…

While last night’s widely telegraphed Star Ratings delivered clear winners [HUM, CLOV, Devoted Health (pvt)] and losers [ALHC] (and a mixed bag for UNH, CVS, ELV, CNC, and MOH), potentially underappreciated methodological choices by CMS…

Despite lopsided stakeholder opposition, we continue to expect CMS to finalize largely as initially sought its CY27 proposal cutting Medicare reimbursement for 337 common non-contrast imaging procedures at grandfathered off-campus hospital outpatient departments (HOPDs) while…

It is no surprise that a Democratic takeover of even one House of Congress will lead to ambitious, aggressive and continuous investigations into the Trump administration, President Trump’s family and associates, and companies that have…

Following yesterday’s oral appellate arguments over HUM’s challenge to Medicare Advantage (MA) risk adjustment-related audit rules, we believe a majority of the three-judge panel is likely to side with the company and the lower court…

While CMS’s finalized GLOBE most favored nation (MFN) rule for Medicare Part B meaningfully narrows its reach / implications, we view its methodology for excluding manufacturers participating in the GENEROUS MFN Medicaid model as legally…

With CMS likely to release its final CY27 Medicare Hospital Outpatient Prospective Payment System (OPPS) rule in early November, we continue to expect a substantial cut to Medicare payment for 340B-acquired drugs administered in participating…