HHS Issues Proposed Rule for 2027 Insurance Marketplace
The Department of Health and Human Services (HHS) has published its proposed rule for the 2027 insurance marketplace. The rulemaking reinforces policy trends favoring outpatient and ambulatory care settings, signaling continued pressure on hospital-based reimbursement.
- A primary driver for shifting imaging out of hospitals is cost; one analysis found that moving just 10% of hospital-based care to outpatient settings could save an estimated $125 billion annually, with up to 25% of hospital radiology services being candidates for this transition. - Major commercial payers have been accelerating this trend by implementing policies that restrict reimbursement for MRIs and CTs performed in hospital-based imaging departments, directing patients toward lower-cost, freestanding centers. - Health systems are responding by building out their own "systemness" strategies to capture this volume, as approximately 40% of all radiology procedures are now performed in outpatient imaging centers or clinics rather than acute-care hospitals. - The U.S. mobile and fixed medical imaging services market was valued at $102.4 billion in 2024, with established competitors like RAYUS Radiology and DMS Health leading a moderately to highly competitive landscape. The more specialized global mobile imaging market, featuring players like Alliance HealthCare Services and Shared Medical Services, was valued at $2.09 billion in 2024. - For radiology directors, the push for outpatient efficiency is compounded by significant staffing challenges; the number of diagnostic radiologists decreased by 2.4% in the five years ending in 2021, even as imaging demand grew. This has contributed to market consolidation, with a 349% increase in practices with over 100 radiologists between 2014 and 2023. - Technology is a key factor in optimizing workflows, with the FDA having authorized over 1,000 AI-enabled devices for radiology by the end of 2025. GE HealthCare, Siemens Healthineers, and Philips are among the vendors with the most FDA clearances for these tools.
