Health Brief from The Washington Post

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By Megan R. Wilson

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Rural health shake-ups on deck: WP Intelligence’s health vertical launched Monday, and new health analyst Rebecca Adams has the goods on how federal Rural Health Transformation Fund money may not be the boon to rural hospitals that lawmakers intended. She also writes about tech companies jostling for cash.
CMS releases hospital payment rules: The rules finalize plans to have Medicare reimburse hospital outpatient departments the same rate for physician-administered drugs as it pays a doctor’s office — saving the government millions, but eliminating a lever Congress hoped to use to offset the cost of other health legislation.
Pardon lobbying: A nursing home executive paid $960,000 to lobbyists during his push for a presidential pardon after being sentenced in April to three years in prison for defrauding the government. Months later he secured one — though a Washington Post report shows the White House pushing back against the lobbying tie.

Happy Monday, and thanks for checking in on Health Brief. Speaking of thanks, I want to wish everyone an early Happy Thanksgiving. I’m very grateful to have you as a reader. And a reminder that today is the only issue of the Health Brief newsletter this week. I’ll be back with an issue next Monday, Dec. 1.

In the meantime, here’s a couple of things to watch:

— The Trump administration could be announcing the prices for the 15 drugs subject to Medicare negotiation this year. The Inflation Reduction Act directs the government to announce the numbers by Sunday.

— The White House has also reportedly been mulling ways to address the enhanced Affordable Care Act subsidies that expire at year’s end. That process all seems very volatile, but it’s something to keep an eye on.

Even though I’m not publishing again until next Monday, I’m staying in the loop. Don’t hesitate to reach out with any health policy tips or intel. Email me at megan.wilson@washpost.com, or message me securely on Signal at megan.434.

This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence.

Rural hospitals such as this one in Romney, West Virginia, are clamoring for a piece of the $50 billion Rural Health Transformation Fund. (Ricky Carioti/The Washington Post)


	The Lead Brief

WP Intelligence’s health care vertical launches today with a bang: My new colleague, health analyst Rebecca Adams, is out with an amazing report about the Rural Health Transformation Fund that’s full of great data, graphics and a ton of insights — plus, it’s a little scoopy.

Republicans set up the $50 billion fund within their massive tax-and-domestic-policy law enacted in July, partially intended to offset the nearly $1 trillion in Medicaid cuts the measure is expected to create. But Rebecca’s report has got the goods about how the money could ultimately not help some rural hospitals to expand their offerings after all.

→ Remember how some lawmakers and experts had been concerned that rural hospitals might scale back or sell their facilities in the wake of projected revenue shortfalls? Well, at least one state, Arkansas, has indicated in its pitch to use the federal funds that, in some cases, those moves might not be the worst idea.

More from Rebecca’s findings: The state is not planning to provide capital to an organization to buy rural hospitals. (A Trump administration spokeswoman confirmed that wouldn’t be allowed anyway.) But officials in Arkansas are open to “facilitating acquisitions, partnerships or affiliations by financially stable health systems, nonprofit organizations, or regional networks.”

Why it matters: Acquisitions have been a factor in rising costs, and studies show that buyouts can contribute to a decline in quality or access. It’s too early to know how that would play out, but it is certainly worth watching.

HOW THE PLAN WOULD WORK

I’ve got some bonus details from Rebecca’s notebook that aren’t in the report:

First, if the Centers for Medicare and Medicaid Services approves the plan, the state could help financially strapped rural hospitals better analyze their finances.

For instance, the plan could help hospitals find ways to bolster their bill collection efforts if they’re “not collecting enough cash,” Arkansas Department of Finance and Administration Secretary Jim Hudson told Rebecca. “We can help them understand what they need to do to make that better.”

Then, should rural hospitals want to be sold, the state’s proposal could support that, Hudson said, by finding “eligible categories of funding that would make that transaction easier for the acquiring system.”

He said Arkansas could help address “inefficiencies” or aspects of “financial drain” — such as problems with staffing or infrastructure — and “provide some operational money or some capital expenditure money to take out those inefficiencies so that it will be an easier thing for a system coming in to say, ‘Yeah, that’s a financially advantageous transaction for us.’”

→ As an example, Hudson said Arkansas might consider ideas such as “providing funds to decommission space” or to “redeploy some workforce from an area that’s underutilized to something that’s going to be more utilized.”

“It assumes the regional hospital, the rural hospital, wants to do the transaction as well,” he adds. “We’re not forcing anybody.”

DIVE DEEPER

That’s just a small slice of Rebecca’s findings. Her report largely focuses on how the Trump administration views the fund as a catalyst for restructuring America’s rural health care system through a growing emphasis on technology and new partnerships.

It’s based on interviews with 17 people, including representatives from health care tech-related companies, researchers, investors, former government officials, rural health and hospital trade association officials, consultants, and state officials.

→ Her first report is going across the paywall, so click HERE to read the entire thing for free. If you want to reach out and say hi — you should! — her email is rebecca.adams@washpost.com. You’ll be seeing her stuff on the regular: I’ll be featuring her weekly analysis and reporting in this newsletter going forward.


	Executive Health Brief

The Trump administration is moving forward with a plan to have Medicare pay hospital outpatient departments at the same rate as doctor’s offices for drugs given by a physician — imposing limited, so-called site-neutral payment policies that hospitals fought to oppose.

CMS rolled out the policy within the agency’s finalized rule for hospital Medicare payments, released on Friday afternoon.

Physician-administered drugs — including chemotherapy medications, certain antibiotics and treatments for autoimmune disorders — cost more when provided at a hospital-owned facility. In comments to CMS during the proposal phase, hospitals pushed back on the administration’s claims that there has been “unnecessary growth” in these hospital-owned outpatient facilities located away from the actual hospital.

The Association of American Medical Colleges said in a statement that the site-neutral policy — in cutting reimbursement amounts — would “harm” the ability of academic health systems and teaching hospitals to “care for the most complex patients.”

What this means for the government’s balance sheet: The site-neutral payment policies would save the government more than $200 million in 2026 alone, according to CMS.

What this means for patients: CMS estimated that it would also save Medicare patients money — a total of $70 million next year in reduced beneficiary coinsurance. The new policy “is particularly important for patients with high utilization of physician-administered drugs, like cancer patients undergoing chemotherapy,” said Mark E. Miller, the executive vice president of health care at Arnold Ventures, in a statement. “They will see significant and welcome reductions in costs by no longer having co-pays up to four times more simply based on who happens to own the building where the service is provided.”

→ A potential consequence: Congress has moved to enact the same limited site-neutral payment policy on drug administration for years — which would have been used to offset other health policy measures. They’ve now lost that line item with the finalization of these rules.

There is appetite from some lawmakers to expand site-neutral payments even more — and groups including Families USA and Arnold Ventures are urging policymakers to go further in the wake of the rule’s release — however, Congress would face fierce pushback from the hospital industry in ways that throw up hurdles to passage.


	Agency alert

There are other intensely watched aspects of the CMS update to hospital payment rules worth highlighting:

— The Trump administration finalized its proposal to phase out Medicare’s inpatient-only list over the next three years — which is just what it sounds like: a list of services that Medicare will only cover if they’re performed in an inpatient setting, typically due to how complex or invasive they are.

This paves the way for more services to be treated at places such as a surgery center rather than at a hospital. Ambulatory surgery centers, or ASCs, are often less costly. I wrote last month about the impact the change could have across the health care sector, including how insurers are closely eyeing the rule change. But, essentially, hospitals worry it could further constrain their finances.

What the trends show: A report from Trilliant Health illustrates the shift away from inpatient hospital care when procedures are taken off the list:

In 2018, knee replacements were taken off the inpatient-only list. The following year, inpatient admissions for Medicare beneficiaries undergoing the procedure decreased by about 18 percent.
In 2020, hip replacements were removed from the list. After that, total hip replacements that occurred on an inpatient basis declined by 35 percent.

“[A] proactive strategy of investing in or partnering with ASCs can help health systems adapt to these changes while also diversifying revenue streams,” the Trilliant Health report reads. Some of this is already happening.

— The finalized payment rules also usher in increased price transparency requirements for hospitals, requiring them to “post real, consumer-usable prices, not estimates, and provide data in standardized formats so patients can understand what their care will actually cost,” CMS said.

The change “empowers patients with financial certainty and the freedom to compare costs — driving competition and lowering prices,” said Cynthia Fisher, founder and chair of transparency group Patient Rights Advocate. “Prices protect patients from overcharges and give them power of proof and recourse.”

Hospitals will be fined if they don’t comply, but the rule says those fines could be reduced by 35 percent if the hospital agrees to waive a hearing before an administrative judge in order to help speed things along.


	Numbers Game

$960,000

That’s how much nursing home magnate Joseph Schwartz paid a pair of lobbyists in his quest for a pardon. He was sentenced in April to three years in prison for defrauding the federal government out of $38 million. President Donald Trump pardoned him seven months later.

The Washington Post’s Michael Kranish and Aaron Schaffer have the full story on the saga. The figure comes from lobbying disclosure forms covering work from April through June. The lobbyists contacted both the White House and Justice Department as part of their advocacy for Schwartz, according to disclosures.

However, here’s what the White House told Michael and Aaron: “No one from White House Counsel nor [White House pardon czar] Alice Johnson met with the individuals named. Either way, the President is the final decision-maker on all pardons, and any one spending money to lobby for pardons is foolishly wasting funds.” The Justice Department referred them to the White House.

→ The lobbyists, right-wing provocateurs Jack Burkman and Jacob Wohl, are felons themselves, as noted on their lobbying forms. They’ve been convicted or charged in multiple states on fraud charges after they’d engaged in a voter suppression scheme using robocalls that mostly targeted minority communities. The Federal Communications Commission proposed a $5.1 million fine.

Burkman and Wohl have also attempted smears of political figures, including Anthony S. Fauci and special counsel Robert S. Mueller III, with unproven sexual assault allegations that fell apart under scrutiny.

Schwartz’s defense lawyer Kevin Marino, who said he was not directly involved in the pardon process, told my colleagues that Trump’s action was justified because Schwartz was trying to save his business, not trying to enrich himself.


	What We’re Reading

“More states are offering cheap health plans to farmers, with a catch,” Patrick Cooley writes For The Washington Post.

“Why screening for the deadliest cancer in the U.S. misses most cases,” Allyson Chiu writes at The Washington Post.

“Bird flu patient dies, marking second U.S. fatality in 2025,” reports Lena H. Sun at The Washington Post.

“Novo Nordisk’s GLP-1 misses goal in closely watched Alzheimer’s studies,” Jacob Bell reports at BioPharma Dive.

“Elective IVF gains traction. Doctors have concerns,” Carly Mallenbaum reports for Axios.

“Influencers made millions pushing ‘wild’ births – now the Free Birth Society is linked to baby deaths around the world,” Sirin Kale and Lucy Osborne report for the Guardian.

“Kennedy Says He Told C.D.C. to Change Website’s Language on Autism and Vaccines,” Sheryl Gay Stolberg writes in the New York Times after an interview with Health Secretary Robert F. Kennedy Jr.

“Nursing Is No Longer Counted as a ‘Professional Degree’ by Trump Admin,” Jasmine Laws reports at Newsweek.

“He built a nursing home empire despite state investigations. Now, lawsuits are piling up,” Jocelyn Wiener writes for CalMatters.