by Caroline Fife, M.D. | Apr 20, 2026 | Healthcare Payment Policy, Quality Payment Program
Last week I got a call from a hospital that employs two practitioners in their Hospital Based Outpatient Wound Center (HOPD). The clinic manager and the hospital quality officer said that they have employed these practitioners for years, and that, “We just heard about...
by Caroline Fife, M.D. | Apr 17, 2026 | Fight the Good Fight, Healthcare Payment Policy
If you prescribe medications electronically through your electronic health record (EHR), you have almost certainly encountered a “formulary alert” from a patient’s pharmacy benefit plan warning you that you must select a “lower tier” drug before the drug you are...
by Caroline Fife, M.D. | Apr 15, 2026 | Fight the Good Fight, Healthcare Payment Policy, Tales of the Medicare Disadvantaged
Despite the hope that Medicare Advantage (MA) plans would offer valuable supplemental benefits (including dental, vision and hearing benefits), recent studies do not show that MA beneficiaries are getting more supplemental services than those enrolled in traditional...
by Caroline Fife, M.D. | Apr 1, 2026 | Fight the Good Fight, Healthcare Payment Policy
The 2026 Medicare Physician Fee Schedule (MPFS) included a one-year, 2.5% positive update for 2026 Medicare payment. It was better than nothing, but still does not come close to adjusting for inflation. (Physician payments are among the few sectors of medicine that do...
by Caroline Fife, M.D. | Mar 30, 2026 | Fight the Good Fight, Healthcare Payment Policy
I have blogged a lot about the boring topic of Medicare’s contract with Acumen to develop a cost measure for “non-pressure” ulcers (which means diabetic foot ulcers, venous leg ulcers, arterial ulcers, and “generic” chronic ulcers – surgical wounds and traumatic...
by Caroline Fife, M.D. | Feb 20, 2026 | Healthcare Payment Policy, Medicare Audits
By Caroline Fife and Lindsay Horst We’ve been asking you to download your Field Test report for the “non-pressure ulcer” Cost Measure. This issue is important because in the future, CMS can claw back Medicare dollars from a wound care practitioner based on their...
by Caroline Fife, M.D. | Jan 26, 2026 | Field Test Report, Healthcare Payment Policy, Quality Payment Program
This is an official CMS release: Upcoming Specialty Society Office Hours We are holding office hours with specialty societies and organizations to provide information about the upcoming field testing period. These office hours are intended as an informal opportunity...
by Caroline Fife, M.D. | Aug 14, 2025 | Fight the Good Fight, Healthcare Payment Policy
White House, Tech Leaders Commit to Create Patient-Centric Healthcare Ecosystem | CMS Health Technology Ecosystem | CMS “For decades, bureaucrats and entrenched interests buried health data and blocked patients from taking control of their health,” said HHS Secretary...
by Caroline Fife, M.D. | Jul 30, 2025 | Fight the Good Fight, Healthcare Payment Policy
I should leave the coverage interpretation to the professionals. I appreciate all of you who tell me when I make a mistake. Donna Cartwright — who is a genuine expert — provided corrections on that UHC policy: “Epifix and Grafix are the only amniotic...
by Caroline Fife, M.D. | Jul 9, 2025 | Fight the Good Fight, Healthcare Payment Policy
CMS has released Quality Payment Program (QPP) performance data for 2023. Under the QPP, payment “adjustments” (bonuses and penalties) occur two years after the “performance year,” so that 2023 scores impact a practitioner’s 2025 Medicare payments. It’s important to...
