Articles related to INSURANCE

Explore the potential implications of the formation of Risant Health on community oncology, as discussed by industry experts in a recent episode of Cancer Care Business Breakthroughs. Learn about the potential challenges and opportunities this new entity could bring to the healthcare landscape.

Unpacking the landmark summit led by the American Pharmacists Association, it becomes clear that there is a pressing need and opportunity to expand healthcare coverage for pharmacists’ patient care services, promising substantial impacts on patient care and health systems.

Similarities in Quality and Cost of Care: Allopathic vs. Osteopathic Physicians As the medical field continues to evolve and diversify, it is imperative to understand the impact of physician education on patient outcomes and healthcare costs. This comprehensive observational study offers an insightful comparison between allopathic and osteopathic physicians in the context of hospitalized Medicare patients, revealing striking similarities in both the quality and cost of care provided.

The Merit-Based Incentive Payment System (MIPS) is a program that ties Medicare payments to the quality of care provided by physicians. In recent years, the weight of cost measures in MIPS has increased, which could disproportionately penalize oncologists. A study published in JCO Oncology Practice found that the recent increase in the weight of cost measures, combined with lower cost scores, will likely result in lower composite MIPS scores, fewer total payment bonuses, and greater negative payment adjustments for oncologists. In non-oncologists, the maximum penalty decreased from $8,262.82 in 2018 to $7,473.57 in 2022. This suggests that oncologists are more likely to be penalized under the current MIPS scoring system. The researchers who conducted the study believe that the current paradigm of the MIPS scoring system will financially penalize heterogeneous and complex care-driven specialties such as oncology. They recommend that policymakers monitor whether the potential loss in revenue results in altered practice patterns and varying degrees of health care quality for patients with cancer.

The authors explore the clinical and economic evidence of the benefit of rTMS and discuss the impact of restricting access to the therapy through overly aggressive prior authorization practices.

Single-tablet regimen (STR) coverage under qualified health plans (QHPs) varies widely across the US. Although bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) coverage has grown over time, many QHPs in priority jurisdictions for the Ending the HIV Epidemic (EHE) have coinsurance requirements. Delay in QHP coverage and benefit design may hinder access to new antiretroviral treatment (ART) regimens.