News to Note – May 2026

  • The Department of Health and Human Services (HHS) recently issued a memo requiring hospitals to improve the quality of food served to patients during hospitalization. This comes as HHS has turned the food pyramid upside down, and there are several initiatives within the government to reassess the evidence behind many commonly recommended medical practices such as vaccination. Also, there is no data showing that a few days of healthy food in the hospital makes any difference. 
    • Every single reference provided by HHS refers to long-term outcomes from dietary changes, with not one referencing the effect of a short-term adjustment. A recent literature review found that one common practice—giving patients hospitalized with heart failure a low salt diet—made absolutely no difference in outcomes. In fact, the data was so compelling that the Society of Hospital Medicine added low salt diets to their list of “Things We Do for No Reason.”
    • In addition, as we all know, hospitals are highly scrutinized on their patients’ experience and satisfaction. Imagine you have a patient hospitalized with newly discovered cancer. Their meal comes in, and it is, as HHS suggests would be optimal, “a lentil or bean-based entrée with leafy greens and olive oil vinaigrette,” or “plain yogurt with fresh fruit” served with unsweetened tea. Have we improved this patient’s outcome or hospital experience? 
    • Should patients receive dietary education during their stay?  Absolutely. Should every American have ready access to healthy food, so they don’t have to grocery shop at the Dollar Store? Absolutely. But without evidence of benefit, forcing a specific diet on a hospitalized patient makes no sense. 
  • The roll-out of WISeR—a program in which the Centers for Medicare and Medicaid Services (CMS) contracts with artificial intelligence (AI) companies to perform prior authorization in six states—is not going swimmingly.
    • The Electronic Frontier Foundation has sued CMS to get details on what is happening behind the scenes. The group states that, in Texas, only 62% of prior authorization requests are being approved by AI, with half the denied requests becoming approved once a human reviews them.  This percentage is even more shocking when compared to Medicare Advantage (MA) plans which approve 92% of prior authorization requests. 
    • Citing the risks to underserved populations and protected classes, the Electronic Frontier Foundation wants to know how the AI algorithms were trained, how the AI companies are being paid, and how the data is being protected.  
  • The CMS 2027 proposed rules started to appear last month and so far, it seems the only interesting developments involve Inpatient Rehabilitation Facilities (IRFs).  
    • CMS is proposing that all therapy modalities must begin within 36 hours of the day of admission to an IRF. Furthermore, the first interdisciplinary team meeting must be within four days of admission. 
  • The 2027 Inpatient Prospective Payment Services (IPPS) Proposed Rule is out, and two notable items include removal of the comorbid condition (CC) designation for all homelessness codes, as well as a proposal for the Comprehensive Care for Joint Replacement (CCJR) bundled payment program to go national in 2027. 
  • Last month, Dr. Ronald Hirsch had an opportunity to share his thoughts with the National Uniform Billing Committee (NUBC)—the organization that creates billing codes and rules—about widening the use of “against medical advice” (AMA).  
    • As a reminder, he and others are proposing the use of this designation for patients who are discharged to settings that are against the advice of the medical team due to lack of payor authorization for skilled care, and not just for patients who voluntarily insist on discharge prior to the completion of medically necessary hospital care. 
    • While the NUBC was sympathetic, they did not feel that developing a formal definition was within their purview.  Also, they felt the use of discharge status codes to make transfer DRG adjustments would present a significant barrier. 
    • Revenue cycle expert Valerie Rinkle suggested that the NUBC establish a condition code to designate when a patient is discharged to a setting that is contrary to the medical team’s advice, which could then be used by CMS and other payers to exclude that admission from quality measures. 
    • The NUBC agreed to work with stakeholders to explore possible solutions that would allow providers to avoid being held accountable for decisions that are entirely outside of their control. 
  • During the American College of Physician Advisors’ (ACPA’s) National Physician Advisor Conference (NPAC) last month, the new Aetna MA inpatient policy was a topic of frequent conversation. Dr. Joanna Kipnes from Duke presented on how her health system operationalized a response to this problem. Perhaps the most important takeaway was that you cannot address Aetna’s behavior if you are not aware it’s occurring.
    • When your hospital asks to designate a hospitalization as Inpatient and Aetna Medicare approves it, someone has to read the body of the approval notification to discover that Aetna determined the admission was low-severity and would be paid at a lower payment level. Many utilization review staff read “approved” and move on to the next case. 
    • The hospital’s finance team must also carefully watch the payments and look for inpatient claims which are paid at less than the contracted inpatient rate. 
    • Aetna is counting on these steps not happening, so ensure your hospital is finding and fighting every attempt to lower your payment.
    • Jefferson Health is the first organization to file a lawsuit against Aetna for this policy. We may not have a court decision for a long time. But perhaps if enough providers follow suit, the legal costs will lead Aetna to reconsider their policies. 
  • Ten years ago, when CMS removed total knee arthroplasty from the Medicare Inpatient-Only list, they stated that patients who were anticipated to require care in a skilled nursing facility (SNF) after recovery and discharge could still be hospitalized as Inpatient. CMS repeated this guidance in 2018 when they removed total hip arthroplasty from the Medicare Inpatient-Only list and again last year when they started eliminating the list entirely. 
    • However, last month, a hospital was audited by a CMS contractor that denied several inpatient claims for patients who had a rational, well-documented need for SNF care after a non-inpatient-only orthopedic surgery. These patients were hospitalized as Inpatient, remained hospitalized for three days, and were then transferred to a SNF with Medicare Part A coverage for their rehabilitation care.
    • CMS was contacted about this discrepancy, raising concerns that the auditor was ignoring CMS’ own position as clearly stated in a federal regulation. In response, the CMS division responsible for SNF payment issues stated that the auditor was correct, writing: “if the patient was otherwise appropriate for outpatient surgery and the only reason for inpatient status was to access SNF coverage, the denial is likely supportable.” 
    • Many are uncomfortable with telling a Medicare beneficiary who lives alone in a condominium with one flight of stairs at the entrance and another leading to the bathroom and bedroom that they must pay $2,000 a week for SNF care.  Or, that they will have to figure out how to manage at home after their hip replacement, receiving home care visits just a few times a week (and only if they are physically able to get down the stairs to let the nurses and therapists into the building). Is this what CMS envisions for Medicare beneficiaries as they remove surgeries from the Inpatient-Only list?
    • Some continue to feel these patients should be hospitalized as Inpatient to allow access to their Medicare Part A SNF benefit.  If the hospital claim is denied, it can be appealed and, if not overturned, rebilled as a Section 121 Medicare Part B claim, allowing the hospital to receive Part B reimbursement and any applicable medical education payment. Additionally, the patient would retain their SNF coverage because a 121 claim is treated as an inpatient claim for this purpose. We will surely hear more about this topic in the coming months– especially as the January 1, 2028, end of the Medicare Inpatient-Only list approaches.