Ñî¹óåú´«Ã½Ò•îl

The Trump administration is projecting significant declines in premiums for Medicare Advantage plans in 2027. The Centers for Medicare & Medicaid Services said Monday that it expects weighted MA premium costs to decline by more than 16% in 2027 compared to 2026, with Medicare Advantage prescription drug premiums set to decrease by 38% year-over-year. (Minemyer, 9/28)

Medicare Advantage insurance companies anticipate another year of enrollment declines, the Centers for Medicare and Medicaid Services announced Monday. Insurers project Medicare Advantage membership will fall from 36.3 million this year to 34 million in 2027, CMS said in a news release. Companies made a similar prediction for the 2026 plan year that failed to come to fruition. CMS wrote that it expects Medicare Advantage enrollment for 2027 to again be higher than insurer estimates. (Tepper, 9/28)

Medicare Advantage insurance companies chasing individuals who also qualify for Medicaid may encounter new hurdles next year. Starting in 2027, CMS will limit new enrollments in Dual Eligible Special Needs Plans, or D-SNPs, to people enrolled in Medicaid plans from the same carrier. The limitation only exists if the D-SNP holds a state Medicaid contract in an overlapping service area, usually defined as one county. (Tepper, 9/28)

The Comprehensive Care for Joint Replacement (CJR) model saved Medicare $180 million in its final three performance years without changing care quality, according to the program’s final evaluation released Sept. 24. CMS launched CJR in 2016 as its first mandatory bundled payment program, requiring hospitals in randomly selected cities to take financial responsibility for hip and knee replacements and the 90 days after discharge. Hospitals could earn a payment from CMS or owe money back depending on whether episode spending came in under or over a target price. The model ended in December 2024. (Emerson, 9/28)

UnitedHealthcare and TeamHealth have resolved a 5-year-old lawsuit involving alleged fraudulent claims. The insurance giant, which filed suit in October 2021, alleged TeamHealth had fraudulently upcoded tens of thousands of emergency services claims. In the complaint, filed in the Greenville Division of the Eastern District Court of Tennessee, the insurer alleged the claims amounted to more than $100 million in overpayments from the insurer, starting as early as 2016. (DeSilva, 9/28)

University of Iowa Health Care has for years been planning a new bed tower at its main campus in Iowa City. The health system has to turn away transfer patients due to limited capacity, and wait times for some specialty services are unacceptable, said Dr. Denise Jamieson, vice president for medical affairs at the University of Iowa. The $2 billion tower project, which began in 2025, would have eased the pressure. (Hudson, 9/28)

Studies from insurers say AI-backed billing tools used by providers raise health costs. But the companies making those tools say the problem isn’t with AI — it’s with the healthcare billing system. (LaPointe, 9/28)

Ñî¹óåú´«Ã½Ò•îl Health News: She Left After Waiting Hours In The Emergency Room. The ER Billed Her Anyway

Autumn Daniels is no stranger to migraine headaches, which have troubled her since childhood. The migraine tormenting the 32-year-old in April was even worse than usual. After a week of piercing head pain, she went to an urgent care center near her home in Champaign, Illinois, and received an injection of Toradol, a non-steroidal anti-inflammatory drug that usually helps with her symptoms. The doctor at the clinic told her that if the pain didn’t improve, she should go to an emergency room the next day. (Andrews, 9/29)

Kaiser Permanente will lay off 147 employees across several California cities, including Oakland and Pleasanton, effective Nov. 20, the health care provider said in state regulatory filings this month. The workers are in business and administrative functions and do not affect patient care, Kaiser said. (Ho, 9/28)

HCA Healthcare plans to build a new standalone emergency room in the Hollins area of Roanoke County and add a second air ambulance helicopter based in Danville. (Busse, 9/29)

Identical twin physicians who returned to their hometown of Richmond, Virginia, to co-lead the emergency department at a local hospital have been garnering recent media attention. Travan Jasper, MD, and Travis Jasper, MD, have been featured on ABC News, in the Washington Post, and most recently on the CBS Evening News. (Fiore, 9/28)

Memorial Hermann Health System President and CEO Dr. David Callender will retire at the end of the year. Memorial Hermann Chief Financial Officer Alec King will move into the top role Jan. 1, according to a Monday news release. The system has not hired a replacement for King, a spokesperson said. (Hudson, 9/28)

For hospital patients, the incessant beeping and buzzing of alarms from monitors, pumps and other devices can make sleep almost impossible. But all that noise isn’t just annoying; it’s also potentially dangerous. For nurses, the barrage of alarms can be overwhelming, making it easier to tune them out—including when they indicate actual patient deterioration. (Landro, 9/28)