The Trump administration is shaking up how health systems are paid for outpatient care with a plan that could reduce Medicare hospital spending by nearly $11 billion over the next decade.

Why it matters: It's a big step forward for "site-neutral" payment policies that have been touted as a way to save taxpayers and patients money, but that hospitals say will lead to service cuts, especially in rural areas.

Driving the news: Medicare administrators last week finalized a proposal to reduce what the government pays hospitals to administer outpatient drugs, including chemotherapy, at off-campus sites.

• The move would equalize payment rates to hospitals and physician practices for the same services — an idea that Congress debated last year but didn't act on in the face of aggressive hospital lobbying.
• Medicare now pays about $341 for chemotherapy administration in hospital outpatient facilities, compared with $119 for the same service delivered in a doctor's office.
• Medicare next year will also start to phase out a list of more than 1,700 procedures and services only covered when they're delivered in an inpatient setting.

What they're saying: The policy changes will give seniors more choices on where to get a procedure and potentially lower out-of-pocket costs at an outpatient site, CMS said.

• Some health policy experts said the change will help make Medicare more affordable.

The other side: "Both policies ignore the important differences between hospital outpatient departments and other sites of care," Ashley Thompson, a senior vice president at the American Hospital Association, said in a statement.

• "The reality is that hospital outpatient departments serve Medicare patients who are sicker, more clinically complex, and more often disabled or residing in rural or low-income areas than the patients seen in independent physician offices."

Hospitals indicated before the plan was finalized that they'd challenge the policy in court if CMS moved forward.

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The White House has postponed the rollout of a new GOP plan on Affordable Care Act subsidies amid pushback from Republicans in Congress.

Why it matters: The issue could aggravate already frayed relationships with Hill conservatives who oppose an extension of enhanced tax credits that are due to expire at the end of the year.

Driving the news: Some lawmakers were blindsided by reports of a plan to address spiking premiums in ACA markets and calls for a short-term renewal of the aid, MS NOW reported yesterday.

• Trump is still working on a proposal, White House press secretary Karoline Leavitt told reporters. Aides said a plan rollout was never formally scheduled for Monday, even though Treasury Secretary Scott Bessent teased the possibility on NBC's "Meet the Press" on Sunday.
• Spokespeople for Senate Majority Leader John Thune and Speaker Mike Johnson did not respond to requests for comment.

Trump's draft proposal, according to people familiar, would put an income limit on ACA premium tax credits and eliminate $0 premium plans, which Republicans say contribute to fraud.

• The Committee for a Responsible Federal Budget estimates that a proposal with the details that have been reported could cost about $50 billion over two years.

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An oral GLP-1 drug from Novo Nordisk failed to delay the progression of Alzheimer's disease in a pair of clinical trials, dealing a setback to the Danish drug giant's hopes of expanding the market for its semaglutide products.

Why it matters: The maker of Wegovy and Ozempic had said the studies were marked by low probability and huge potential. But the results underscored the limitations of GLP-1s and sent the company's stock falling in early trading yesterday.

Driving the news: Novo said that its oral semaglutide, Rybelsus, did not meet the primary goal of slowing down cognitive decline by 20% in a pair of late-stage trials the company ran over two years.

• However, the company said semaglutide did have an observable effect on unspecified biomarkers connected with Alzheimer's. The company is expected to elaborate on the results at a scientific conference next month.

Between the lines: The results marked another setback for Novo, which has been losing market share in GLP-1s to rival Eli Lilly. Shares in the company fell more than 12% on the news yesterday morning, but recovered slightly and closed down 5.6%.

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Nearly 1 in 10 U.S. adults have been diagnosed with cancer in their lifetime, a new high in Gallup's surveys dating back nearly two decades.

The big picture: Cancer death rates have declined in recent decades, along with incidences of certain types of cancer like lung cancer. But other cancers, notably those associated with obesity, have seen an uptick.

Driving the news: Gallup's data, presented in two-year averages, has shown climbing lifetime cancer diagnosis rates for several years, reaching a new peak in the numbers released yesterday.

• The share of adults who said they had been diagnosed with cancer hovered at or just above 7% from the 2008-2009 period through 2014-2015, before it began to climb.

Between the lines: The seemingly bad news is threaded by a silver lining: One reason for the climb in lifetime cancer rates, Gallup notes, is because people are living longer after their diagnoses.

• But even as more people survive cancer, racial and insurance-driven disparities can limit access to treatment and affect survival rates.

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