Kevin McDugle, MBA

Independent physicians are driving better care and lower costs — and the data proves it. A recent Avalere Health study found that Medicare beneficiaries treated by independent physicians at Duly Health and Care had nearly $7,800 lower annual expenditures compared to those treated by hospital-affiliated providers. Key takeaways: ✅ 25% lower average annual Medicare spending across five specialties ✅ 15% fewer inpatient days and 12% fewer ED visits ✅ More mammograms and procedures done outside costly hospital settings ✅ Coordinated care = even greater savings and better outcomes This data underscores the value of preserving independent practice — for patients, payers, and the broader healthcare system. At Unified Women's Healthcare, we remain deeply committed to supporting independent women’s health providers and ensuring access to personalized, efficient care. The study is linked in the comments if you'd like to read more!

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🚨 Medicare Update: Government Shutdown Impact 🚨 With the 2025 federal government shutdown now underway, CMS has issued several important updates that affect providers: 🔹 Claims Hold- Medicare Administrative Contractors (MACs) have been directed to hold certain claims for up to 10 business days. This precaution helps avoid reprocessing if Congress restores funding or extends flexibilities. Expect payment delays. 🔹 Telehealth Services- Many temporary Medicare telehealth flexibilities expired on October 1, 2025. Without congressional action, providers may need to consider Advance Beneficiary Notices (ABNs) for telehealth services not covered under permanent law. 🔹 Essential Services Continue- Medicare and Medicaid payments are expected to continue, since these programs are not tied to annual appropriations. However, processing may be delayed due to reduced staffing. 🔹 Non-Essential Activities Paused- CMS is scaling back non-critical activities (e.g., some surveys, oversight, and policy development). If you are waiting on a Medicare survey, expect delays. We’re monitoring CMS and congressional updates closely and will keep our clients informed. For now, no action is required, but planning for possible delays is wise. #Medicare #RCM #Telehealth #HealthcareBilling #GovernmentShutdown

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When was the last time you made sure PECOS and all your I&A information was up-to-date in Medicare? “In recent communication, CMS reminded providers and suppliers that their Medicare enrollment could be #deactivated if they fail to report all managing employees. Practices are required to report all managing employees and must have at least one if completing the Form CMS-855A, CMS-855B, CMS-855S, or CMS-20134. Individuals completing the Form CMS-855I do not need to list a managing employee if they do not have one. For more information, see Chapter 10 of the Medicare Program Integrity Manual.” Thanks to MGMA Government Affairs for the reminder!

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I was asked a great question yesterday.... Are insurance companies or hospitals going to feel more pain in the coming years? (Patients and businesses aside) My answer? Insurance companies Why? Utilization is up and insurance companies can't control utilization They just react to it Healthcare providers are the one's who have more control over this But when you have a system incentived by RVUs and volume... Utilization is not going down And insurance companies will have to pay Or increase denials :) Reimagining care delivery is of the utmost importance along with breaking the payor/provider relationship #healthcare #business #insurance #hr #ceo #benefits #hospitals #questions

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