MedPAC Explores Alternative Part B Reimbursement Options to Current ASP+6% Rate
This week in healthcare, MedPAC considers alternate forms of reimbursement for Medicare Part B and critics of CMS’s new oncology model argue it puts too much risk onto providers.
The Medicare Payment Advisory Commission (MedPAC) has begun to explore potential alternatives to its current Part B reimbursement practices. ACcording to this article, “one alternative would replace the [standard] 6% markup with a flat add-on payment and the other would combine a percentage markup plus a flat payment.”
While CMS’s value-based oncology model aims to streamline cancer care, some critics argue that the model “could adversely impact optimal patient care by placing oncologists at risk for chemotherapy drugs.”
While reference pricing may be one strategy to combat rising health care costs, this article argues that “reference pricing raises issues regarding consumers’ quality of and access to care, as well as possible discrimination against sick patients.”
A new report from the Centers for Disease Control and Prevention (CDC) has found that “two out of three Americans with invasive cancer—the kind that has spread to nearby healthy tissue—are living five years or more after diagnosis.” The report also stated that the five most common cancer types were prostate, breast, lung, and colon and rectum.
According to a recent report, prescription drug spending in the US rose “more than 12% last year”. A major driver? The “soaring” demand for and cost of expensive drugs for hepatitis C, diabetes, and cancer.
Recently BlueCross BlueShield of Tennessee and Tennessee Oncology announced a six-month pilot program. According to a statement, “the pilot should lead to better symptom management, fewer emergency room visits and fewer unnecessary treatments,” and patients “will also have 24/7 access to a team of care coordinators trained to help manage their care plans and answer questions.”
CMS’s announcement of its new ACO program causes us to take a look at a proposed rule change that would allow ACOs to receive fee-for-service payments AND shared savings payments. As this analysis notes, “This rule change opens up a third type of shared savings with a savings rate up to 75% (compared to 50 or 60% in other tracks).”
Want more health care landscape updates and insights? Follow us on Twitter @innovpartners.