Morning, Marco. Quiet news day, one item that actually matters for your admissions.
A drug-resistant fungus has been quietly climbing through the CDC's weekly notifiable
data all summer and has now shown up in 27 states — including a lot of the
post-acute pipeline your patients come through. That's the one to read. Everything
else is smaller. Coffee, then sleep.
A · Top Stories
Three items. The first one is new to this report.
Candida auris now in 27 states — 3,437 clinical cases so far this year
CDC's weekly notifiable-disease tables through the week ending July 25 put 2026
clinical C. auris cases at 3,437 across 27 states, and the numbers got
picked up broadly in the press over the past week. California leads with 873 —
roughly a quarter of the national total — followed by Texas (433), Tennessee (283),
Ohio (279), Georgia (193), Louisiana (179), and Illinois and Arizona (171 each).
Arizona is up nearly 30% year over year. For scale: 48 cases nationally in 2016.
Why it matters to you
Almost none of these are community-acquired. The organism moves through skilled
nursing facilities, long-term acute care hospitals, and vent units, then arrives at
your door as an admission — usually colonized, not infected, and asymptomatic.
CDC's standing recommendation is active surveillance on admission to acute care for
patients who recently resided in a SNF or LTACH. That's a meaningful share of your
overnight admits. It's also the kind of protocol that exists on paper in the IP
manual and does not reliably fire at 3 a.m. when the trigger depends on someone
typing the right thing into the admission note.
Worth doing: ask infection prevention one question — what actually
triggers a C. auris screening swab on your unit, and is it keyed to
"admitted from SNF/LTACH" as a discrete field or to free text? If it's free text,
it isn't firing.
CDC tracking page ·
CNN explainer, Aug 7 ·
state-by-state counts
Florida awards $188M in rural health money — $45M of it to the Southwest region
The governor's office announced roughly $188 million in Rural Health Transformation
Program awards yesterday, administered through AHCA: more than 80 awards across 31
rural counties serving about 1.2 million Floridians. By region, Northwest took the
largest share (35 awardees, $81M), then Northeast (14, $51M), Southwest
(21 awardees, $45M), and Southeast (11, $12M). Recipients are a mix of
rural hospitals, FQHCs, rural health clinics, and workforce programs.
Why it matters to you
Lee County isn't rural, but your transfer-in pattern is shaped by what Hendry,
Glades, Charlotte, and DeSoto can and can't hold overnight. Money aimed at rural
hospital capacity and workforce is, downstream, money aimed at how many elderly
patients get shipped east to you at 1 a.m. because the sending facility couldn't
staff a med-surg bed. Whether it changes anything depends entirely on whether the
Southwest awards went to inpatient capacity or to clinics and training pipelines —
the award list is worth two minutes.
Talking point: ask your transfer center whether any of the SWFL
awardees are facilities that currently send you patients. That's the only version of
this news with an operational consequence.
Florida Phoenix ·
WFSU
Update: the FY2027 IPPS fine print — advance care planning becomes a measured item, VTE prophylaxis stops being one
We covered the FY2027 IPPS final rule's headline numbers on August 1 (net 2.3%,
~$2.1B, new sepsis readmission measure). The quality-measure detail underneath is
the part that actually touches your documentation. CMS adopted an
Advance Care Planning eCQM and a Hospital Harm–Postoperative VTE
eCQM beginning with FY2030 payment determination, and made the
Malnutrition Care Score eCQM mandatory for FY2030. At the same time
it is removing three measures for FY2030: the VTE Prophylaxis eCQM,
the ICU VTE Prophylaxis eCQM, and Discharged on Antithrombotic Therapy.
Why it matters to you
The direction of travel is clear: CMS is retiring measures that count whether you
ordered a prophylactic and adding measures that count whether a conversation was
documented in a structured field. Goals-of-care discussions you already have on
nearly every elderly admission will start being scored — but only if they land in
the discrete ACP element, not in your H&P prose. Also worth knowing: several
readmission and mortality measures are adding Medicare Advantage patients and
shortening the look-back from three years to two, so your hospital's numbers will
move for reasons that have nothing to do with a change in care.
Worth raising at the next group meeting: where does an advance care
planning discussion have to be documented in your EHR to count as an eCQM
numerator? Ask before FY2030 reporting builds, not after.
CMS fact sheet (CMS-1849-F)
B · The Debate
One topic, both sides, no verdict.
Should Medicare pay the same amount for a service regardless of where it is delivered?
Why it's live right now: CMS's CY2027 Outpatient PPS proposed rule,
released July 2, would extend site-neutral payment to certain non-contrast imaging
furnished in grandfathered off-campus hospital departments, reimbursing them at 40%
of the OPPS rate. The comment window closes August 31, and hospital groups and
market-oriented policy shops are filing on opposite sides of it.
The case for site-neutral
Paragon Health Institute, in its OPPS comment filings
A hospital outpatient department and a physician's office performing the same
drug administration or the same non-contrast scan are producing the same thing,
and paying more for one than the other is a subsidy for a building, not for
care. Paragon's argument is that the payment gap does not sit still — it creates
a standing incentive for health systems to acquire independent practices and
re-bill the identical service at the higher rate, raising prices without raising
quality, and that the gap is projected to keep widening. CMS's own estimate for
the earlier round of these reforms was $210 million in program savings and $70
million in beneficiary out-of-pocket savings in a single year. Coinsurance is a
percentage, so patients pay the differential too.
Paragon on the OPPS/PFS rules
The case against
Rick Pollack, President & CEO, American Hospital Association
The two settings are not interchangeable, and pricing them as if they were
mistakes an accounting identity for a clinical one. Pollack's position is that
hospital outpatient departments treat sicker, poorer, more medically complex
patients — a disproportionate share dually eligible for Medicare and Medicaid —
and carry obligations an independent office does not: EMTALA, 24/7 standby
capacity, a far heavier regulatory and life-safety code burden, and the
emergency infrastructure that has to be staffed whether or not it is used that
day. Cutting the outpatient rate does not make that overhead disappear; it makes
the service uneconomic to offer, and the departments most exposed are the ones
in communities with the fewest alternatives.
AHA statement on the CY2027 OPPS proposed rule
Where it might land: comments close August 31; the CY2027 OPPS
final rule normally lands in early November.
One question for IP, one for the group, and three episodes of a man hitting people.
That's the whole day. Sleep well, Marco.