This article discusses a Brown University study showing that commercial insurers pay nearly $1,500 more per procedure at hospital outpatient departments than at ambulatory surgical centers. The findings highlight large price variations across insurers and suggest opportunities for cost savings through selective contracting or site-neutral payment reforms.

Hospitals are discouraging infection testing to avoid Medicare penalties, a practice clinicians say jeopardizes patient safety and skews public reporting. As Brown University’s Andrew Ryan put it, “Basically, the measures are just really, really bad … this is honestly the worst” pay-for-performance program, underscoring deep flaws in how infection penalties are designed and enforced.

UnitedHealth’s Medicare Advantage program has come under scrutiny for allegedly exploiting diagnostic “upcoding” practices that drive billions in excess federal payments. Brown University researchers have launched Medicoding.org, a public tool that tracks how diagnostic coding in Medicare Advantage inflates payments to insurers. Health economist David Meyers explains that while some coding reflects real patient needs, much of the increase stems from insurers “gaming the system,” making beneficiaries appear sicker than they are