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OBR OncologyOncology Groups Face Drop in Reimbursement Due to Outdated Medicare Data

Updated Conversion Factor Could Negatively Impact Cancer Care, Say Leading Oncology Organizations

The American Society of Clinical Oncology (ASCO) and the Community Oncology Alliance (COA) have voiced their concerns over the Centers for Medicare and Medicaid Services’ (CMS) proposed changes to the Medicare Physician Fee Schedule (MPFS) for 2024. Both organizations emphasize that the updated conversion factor could have a detrimental effect on cancer care, particularly in the areas of radiation and surgical oncology.

HCN Medical Memo
The proposed changes to the MPFS could have a significant impact on the quality and accessibility of cancer care. The decrease in the conversion factor is particularly concerning, as it comes at a time when the healthcare system is already strained by inflation and the ongoing pandemic. It is crucial to stay updated on these changes and consider how they may affect your practice and patient care.

Key Points
  • ASCO and COA have submitted comments to CMS about the proposed MPFS, which is set to take effect on January 1, 2024.
  • The updated conversion factor is $32.75, a decrease of $1.14 or 3.34% from the 2023 conversion factor.
  • The decrease comes at a time of sequestration payment cuts, inflation, and increased oncology costs due to delayed cancer screenings during the COVID-19 pandemic.
  • Hematology/oncology will see a 0.2% decrease in Medicare allowable rates, radiation oncology a 3.6% drop, gynecologic oncology a 0.7% decrease, and surgical oncology a 2.9% decline.

In the past 32 years, the conversion factor has increased by only $1.75, or 5.36%, while overall inflation has risen 118%.

Additional Points
  • CMS cannot adjust the conversion factor alone; Congressional action is required.
  • Both ASCO and COA support other aspects of the proposed MPFS, including extending telehealth flexibilities through 2024.
  • Mary Bird Perkins Cancer Center supports the CMS proposal to cover dental services before cancer treatment to prevent osteonecrosis.

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