Roy Edroso

Baltimore, Washington, D.C.

Editor at Decision Health

Editor at Part B News

Blogger at Roy Edroso Breaks It Down

the only guy on Substack who isn't constantly blubbering about cancel culture! also: @edroso.bsky.social

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Articles

Budget bill would peg physician pay to MEI; might me...

1 day ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

The budget bill passed on May 22 in the U.S. House of Representatives, now being considered by the Senate, has a proposed change to the physician fee schedule conversion factor (CF) that, while it doesn’t appear to do anything about low reimbursement rates in 2025, promises some relief in 2026 and possibly in years to follow. But experts caution that the gains may not be what they at first appear. You must log in to view the content you requested.
To ease doctor-departing woes, write careful terms i...

3 days ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

If you’re worried that one of your employed physicians will want to leave before their contract expires, be aware that the best time to handle that problem is when they first sign on. Also, remember that “I quit” isn’t always the end. You must log in to view the content you requested. Not a subscriber?
Consult the details for MDM discussions for accurate...

3 days ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

Question: When our doctors requests a consult from another doctor, how can we tell whether our physician can count the conversation toward “discussion of management or test interpretation with external physician or other qualified health care professional or appropriate source (not separately reported)” in the data review column for medical decision-making (MDM)?
Brace for tariff impact on lab equipment, syringes, ...

6 days ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

Heads up: While President Trump continues to alter the tariffs he announced in February, it’s likely that some of your equipment prices will be affected, and you should prepare for cost fluctuations. You must log in to view the content you requested. Not a subscriber?
CMMI pivots include ‘inferred risk,’ possible end of...

1 week ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

A white paper, press release, and interview with the new director of CMS’ Center for Medicare and Medicaid Innovation (CMMI) suggest significant changes to innovation and accountable care models such as the Medicare Shared Savings Program (MSSP) and to Medicare Advantage. You must log in to view the content you requested. Not a subscriber?
A cancer on the ex-Presidency

2 weeks ago | edroso.substack.com | Roy Edroso

BOLT UPRIGHT: Good evening, I’m Bolt Upright and this is Received Opinion![A marching band version of the screams of the damned. On the screen behind UPRIGHT: A limited action cartoon of a drooling Joe Biden squinting at the camera, then x’s appearing over his eyes and his hands folding over his chest and clutching a lily, then him turning into skeleton. This transformation cycles.
Physician associates continue to rise, in price and ...

2 weeks ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

New findings from the American Association of Physician Associates (AAPA) show that PAs remain a growth industry — not only in number and compensation, but also in independent practice. You must log in to view the content you requested. Not a subscriber?
Decode the independent interpretation of tests for E...

3 weeks ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

Make sure your staff know when they can count the independent review of a test toward medical decision-making (MDM). Independent interpretation of a test can lift the level of the “amount and/or complexity of data to be reviewed and analyzed (data)” element of an E/M visit to moderate or extensive, depending on the work performed for an encounter. You must log in to view the content you requested. Not a subscriber?
Trump tries ‘Most Favored Nation’ drug pricing again...

3 weeks ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

On May 12 the Trump administration announced a revival of the “Most Favored Nation” (MFN) drug pricing executive order (EO) similar to one it unsuccessfully tried to implement in President Trump’s first term. Apart from including Part D drugs and some more aggressive language than last time, administration officials did not immediately say how this attempt would achieve a different result. You must log in to view the content you requested.
OK to promote your practice to outside patients, but...

3 weeks ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

The recent closure of a major practice in Rhode Island, and the efforts of a separate practice to pick up their patients, raises the question: Is it out of line to actively solicit another provider’s patients? You must log in to view the content you requested. Not a subscriber?