The Service Line

This week’s Service Line ran three specialty deep dives instead of the usual six. A publishing outage knocked Monday, Wednesday, and Friday off the schedule, and we would rather tell you that plainly than pretend the gap is not there. The three issues that did run, cardiology, women’s health and maternity, and pharmacy and PBM, land on the same regulatory moment from different angles: a single Medicare fee schedule closing comments on the same day for two specialties at once, a hospital access story that repeated itself on opposite sides of the country the same night, and a drugmaker showing that winning in court does not actually stop a pharmacy network from shrinking. Below are the five items a cross-specialty operator should not have missed from the three issues that published, plus what connects them. Confidence: High on the outage and on every item below, each already sourced and published earlier this week.

Cardiology: CMS closed a nine-month coverage fight, and the volume floor now falls on individual operators alone

The Centers for Medicare and Medicaid Services (CMS) finalized its rewritten National Coverage Determination for transcatheter aortic valve replacement (TAVR) on September 10, dropping the evidence-development registry requirement for symptomatic severe aortic stenosis, the population that drives nearly all TAVR volume, while keeping asymptomatic coverage research-only. Hospitals lost their separate facility-level volume minimum; individual operators did not, and now must clear 20 transcatheter valve procedures a year, 15 or more of them TAVR, to keep billing Medicare. The multidisciplinary heart team, at least one cardiac surgeon plus one interventional cardiologist, survives intact. CMS TAVR decision memo.

Women’s Health and Maternity: two hospitals, 1,300 miles apart, stopped delivering babies the same night, for opposite reasons

Fitzgibbon Hospital in Marshall, Missouri emerged from bankruptcy this year, sold itself for $10.5 million, changed its name, and ends labor and delivery September 30 after years of losses. Henderson Hospital outside Las Vegas, owned by the Fortune 500 chain Universal Health Services, ends maternity and neonatal intensive care unit services the same night, not because it is broke but because its parent wants the 62 beds for emergency and medical-surgical capacity instead. Rural financial collapse and a profitable system’s capacity math produced the identical symptom on the identical night: fewer places to give birth. Fitzgibbon Hospital to end inpatient labor and delivery services, ABC17News, Henderson Hospital shutting down maternity, NICU units, KTNV.

Pharmacy and PBM: CMS asked the industry to write its own rulebook for Part D pharmacy contracts

CMS published a formal request for information on September 24 asking pharmacies and pharmacy benefit managers to help define what counts as a “reasonable and relevant” Medicare Part D pharmacy contract, with comments due November 23. Whatever standard results will govern Part D network pharmacy contracts starting the 2028 plan year, effective January 1, 2029, making this comment period the last real chance to shape language that binds for years. CMS’s Part D reasonable and relevant pharmacy contracting RFI.

Pharmacy and PBM: Merck just showed hospitals how little a winning lawsuit protects them

Merck notified 340B covered entities on September 23 that hospitals without their own outpatient pharmacy will be limited to a single designated contract pharmacy for its 340B-priced drugs starting October 1. The timing lands the same week a federal court denied manufacturers’ injunction bid against New Mexico’s contract pharmacy access law and a federal appeals court denied rehearing in a similar Missouri case, so states keep winning in court even as individual manufacturers keep narrowing their own networks unilaterally, drug by drug. Merck’s 340B Program Integrity Initiative letter.

Women’s Health and Maternity: Texas’ own Medicaid computer system lost track of who still qualified for postpartum coverage

A Texas Health and Human Services Commission Office of Inspector General audit published September 4 found the state’s eligibility system, which decides Medicaid and Children’s Health Insurance Program coverage for the roughly 339,000 pregnant, perinatal, and postpartum Texans the programs cover in an average year, could not reliably confirm its own eligibility data. In a 15-case sample, two people with terminated eligibility missed 5 and 10 months of postpartum coverage they were owed; a separate internal review of 2,248 terminations found 534 were wrong. HHSC’s fix is not due until August 2028. Texas Medicaid and CHIP Eligibility Determinations in TIERS, Texas HHSC Office of Inspector General.

Connective Tissue: one Medicare rule, two specialties, the same September 14 deadline

Cardiology and women’s health closed comments on the exact same federal rulemaking the exact same day. The American College of Cardiology’s ask to delay the mandatory heart-failure payment model and reverse cuts to structural and imaging codes, and the American College of Obstetricians and Gynecologists’ fight over whether Medicare runs one obstetric billing system or two, both went into the Calendar Year 2027 Medicare Physician Fee Schedule proposed rule before its September 14 comment deadline. CMS is expected to finalize that single rule in early November, meaning the same agency decision will simultaneously set cardiology’s mandatory-model terms and obstetrics’ billing structure. Pharmacy’s own comment clock, the Part D “reasonable and relevant” contract RFI, runs on a longer, separate track into November 23, but it is the same pattern: a comment window most operators are not watching is where a specialty’s multi-year economics actually get decided. An operator in any specialty should know which open federal comment period governs its own billing codes, not just the ones with a press release attached.

This Week’s Operator Metrics, At a Glance

• Cardiology: 20 transcatheter valve procedures a year, 15 or more of them TAVR, the new Medicare operator floor now that hospitals no longer have a separate facility minimum.
• Women’s Health and Maternity: 50 percent, the share of large US employers now covering in vitro fertilization, up from 22 percent seven years ago.
• Pharmacy and PBM: over 80 percent of hospital pharmacy directors report a shortage of experienced pharmacy technicians, a gap technicians themselves say pay would fix.