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Week in Washington 11/06/25

Shutdown – Generally no updates on the shutdown, which will be the longest in US history. Several observers noted that this week’s election, which favored Democrats, could change the dynamics of the shutdown. There continue to be some conversations on potential off ramps/policy compromises but no leadership level conversations. Two shutdown related stories Tariffs – ... Continue reading

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Events & More

Value Based Care Advisory Services: HMA and Wakely Put Analysis into Action

November 20, 2025
1:00 PM ET

Join experts from HMA and Wakely, an HMA Company, for an inside look at how our teams help organizations navigate and thrive in the value-based landscape. This session will highlight case studies and recent work that demonstrate a comprehensive advisory solution for any value-based entity. Attendees will gain a deeper understanding of how integrated insights across strategy, analytics, and implementation can drive measurable results in value-based care.

Learn more and register

Newsworthy Findings

Federal ACA Enrollment Kicks off Without Action on Subsidies

Millions of Americans are facing steep price hikes for Affordable Care Act coverage while Congress dithers over the issue. Experts say there’s not as much time to act as legislators may believe.

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Editor's Note
As open enrollment for ACA begins, enhanced subsidies are set to expire at the end of the year, creating the potential for large premium hikes in 2026. If Congress doesn’t act soon, millions could face unaffordable coverage or lose insurance entirely.

Medicare Finalizes Controversial Cut to Specialty Care Next Year

The CMS finalized the Medicare physician fee schedule for 2026 on Friday, one day before the statutory deadline. The massive payment rule includes a so-called “efficiency adjustment,” which reduces payment for thousands of services including surgeries, outpatient interventions, pain management and more starting next year.

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Editor's Note
CMS is applying a -2.5% “efficiency adjustment” to many specialty services in 2026, arguing that these procedures have become easier to perform and are currently overpaid, while increasing support for primary care. Specialty physician groups strongly oppose the change, saying it’s based on flawed assumptions and will lead to significant reimbursement cuts that threaten practice sustainability.

Nonprofit Health Systems Unveil ACA Plans Amid Ongoing Florida Blue Contract Dispute

Two South Florida nonprofit health systems have launched a new marketplace health plan under 22 Health through their jointly-owned Community Care Plan, offering bronze, silver and gold ACA options with in-network care and “$0 monthly premiums for many” amid a contract dispute with Florida Blue.

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Editor's Note
The move highlights how provider systems are responding strategically to payer tensions by entering the insurance space themselves, signaling a shift in power and a reshaping of marketplace dynamics.

Amid Shutdown, Health IT Vendors Say Hospitals Are Cutting Back on Spending

A survey by Black Book Market Research of 107 healthcare IT vendors found that 71% had one or more procurements paused and 68% were seeing new RFPs delayed, as hospitals facing cash-flow stress amid the federal shutdown shift spending toward short-term ROI tools like revenue-cycle and cybersecurity platforms.

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Editor's Note
The abrupt pivot from strategic, long-term tech investments toward “must-have” purchases reveal how financial fragility in the broader health-system sector can ripple swiftly through innovation and infrastructure planning.

Legislators Object to Proposed CMS Payment Changes for Diabetes Tech

In a letter to CMS Administrator Dr. Mehmet Oz, diabetes caucus leaders raised concerns that the agency’s proposals will reduce access to glucose monitors and insulin pumps.

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Editor's Note
Earlier this year, CMS proposed including insulin pumps and glucose monitors in a competitive bidding program—shifting payment from upfront purchases to a monthly rental model. While the agency aims to improve cost efficiency, critics warn this approach could reduce supplier participation and restrict beneficiaries’ choices. Lawmakers argue that payment reforms should balance fiscal responsibility with ensuring continued access to essential diabetes technology.

Bonus Article

Just for Fun

Math Joke:

I’ll do algebra, I’ll do trigonometry, and I’ll even do statistics…
But graphing is where I draw the line.

Prior Week

Q: Why did the polynomial get therapy?

A: It had too many unresolved roots

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