Executive analysis on the forces shaping healthcare reimbursement — CMS and payment policy, commercial payer strategy, Medicare Advantage, and healthcare M&A and economics. Signal, not noise, for the decisions that matter.
CMS has proposed the CY2027 Physician Fee Schedule: two conversion factors, a second efficiency adjustment, a rebuilt practice-expense method, a Modifier-25 payment cut, and more. A specialty-by-specialty read on CMS-1848-P — and how tightening Medicare reimbursement rolls downstream into commercial contracts. Comments close September 14, 2026.
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A 37% cut to 340B drug payment, a 6.6% cut to office infusion administration, and a widening HOPD / office gap — modeled by code.
Fulcrum Intelligence·Aug 2026·15 min readWhite bagging is usually argued as a drug-sourcing and safety question. For a rheumatology practice it is first an economic one — and the payer contract, not the pharmacy debate, decides how it ends.
Fulcrum Intelligence·Aug 2026·11 min readIn buy-and-bill infusion the biggest dollars — and the biggest leaks — sit on the drug line. J-code units, waste modifiers, and contracted rate quietly erode margin on every cycle.
Fulcrum Intelligence·Aug 2026·10 min readThe Qualifying Payment Amount is the plan’s number, not the final one. For hospital-based groups, a disciplined federal IDR program turns a contested anchor into defensible payment.
Fulcrum Intelligence·Aug 2026·9 min readFor emergency medicine and anesthesiology, batching decides whether low-dollar claims are worth disputing at all. The 2026 rules — a 50-item cap and a $15 fee — rewrote the math.
Fulcrum Intelligence·Aug 2026·9 min readEmergent surgical care often happens out-of-network and without patient choice — which places it inside the No Surprises Act. Eligibility and evidence, not the sticker rate, decide the outcome.
Fulcrum Intelligence·Aug 2026·9 min readMedicare has underpaid complex spine care for two decades, and many commercial contracts import the cut through a percentage-of-Medicare peg. Commercial contracting is the decisive lever.
Fulcrum Intelligence·Aug 2026·9 min readA urology group’s leverage is unevenly spread across its payers. Covered-lives and market-share intelligence turn a long contract list into a ranked plan for the negotiations that move margin.
Fulcrum Intelligence·Aug 2026·8 min readBiosimilars and ASP erosion are thinning the anti-VEGF spread while step therapy dictates agent choice. Coding, waste capture, and step-therapy discipline decide what the practice keeps.
Fulcrum Intelligence·Aug 2026·9 min readAnesthesia subsidies are usually explained as a workforce shortage. That is only half the story — and the difference determines what a hospital or ASC can actually do about them.
Fulcrum Intelligence·Aug 2026·14 min readA specialty-by-specialty read on proposed rule CMS-1848-P — and how tightening Medicare reimbursement rolls downstream into commercial contracts.
Fulcrum Intelligence·Jul 2026·12 min readCommercial rates are diverging from Medicare faster than most organizations realize — and the gap is now a strategy problem, not a rate problem.
Fulcrum Intelligence·2026·7 min readWhere commercial reimbursement sits relative to Medicare in 2026 — and how to use benchmarks without being misled by them.
Fulcrum Intelligence·2026·7 min readThe organizations holding rate walk into negotiations with the same data the payer has. Most providers still don’t.
Fulcrum Intelligence·2026·6 min readThe premium hospitals earn for outpatient care is the exact target of site-neutral policy and payer steering. Defending it requires knowing what it’s worth.
Fulcrum Intelligence·2026·6 min readThe Federal IDR process was built for a trickle of disputes and got a flood. Three years in, the data tells hospital-based groups where the leverage actually sits.
Fulcrum Intelligence·2026·7 min readPayers are steering procedures to lower-cost settings faster than most organizations have repriced for. The question is whether you shape that shift or absorb it.
Fulcrum Intelligence·2026·6 min readPayers want volume in ambulatory surgery centers. That demand is leverage — if you negotiate the rate before you accept the volume.
Fulcrum Intelligence·2026·6 min readMost value-based arrangements never escape pilot purgatory. The ones that scale share a small set of design choices — and a lot of measurement discipline.
Fulcrum Intelligence·2026·6 min readDemand has never been higher and parity is the law — yet reimbursement and network adequacy remain the sector’s binding constraints.
Fulcrum Intelligence·2026·6 min readBuy-and-bill spreads are compressing, site-of-care steering is intensifying, and policy is reshaping the margin on every infused dollar.
Fulcrum Intelligence·2026·7 min readRadiology is squeezed from both ends — fee-schedule pressure on the technical component and payer steering on the professional. Margin defense is a data exercise.
Fulcrum Intelligence·2026·6 min readMedicare Advantage now covers the majority of eligible beneficiaries — and its payment behavior increasingly sets the tone for the rest of the book.
Fulcrum Intelligence·2026·7 min readConsolidation has changed who sits across the negotiating table — and how reimbursement is won, defended, and scrutinized.
Fulcrum Intelligence·2026·6 min readDeal logic has shifted from growth-at-any-cost to reimbursement durability. In 2026, the quality of the rate is the quality of the deal.
Fulcrum Intelligence·Mid-2026·6 min readAn anonymized look at how disciplined contract analytics and underpayment recovery turned a routine renewal into a multimillion-dollar result.
Fulcrum Intelligence·2026·5 min readNo insights match your search. Clear filters →
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National benchmarks, payer behavior, and the rate strategy playbook for the year ahead.
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Contract analytics and payment-variance review surfaced years of underpayments across a multi-hospital system — recovered and prevented going forward.
A coordinated, multi-payer negotiation strategy lifted commercial reimbursement across a PE-backed, multi-state specialty platform.
A cost-based reimbursement and service-line plan delivered a sustainable path forward for an at-risk Critical Access Hospital.
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