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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.

Orthopedic surgeon Dr. Ahmed Siddiqi wanted to find a better approach to postoperative monitoring – one that came closer to direct, continuous visibility of patient progress during recovery – while reducing the burden on patients and the management team. His new digital care solution enabled his team to provide long-term remote patient monitoring while directly communicating with all patients. The platform’s remote therapeutic monitoring (RTM) module helps the team meet the minimum engagement and data submission requirements to be eligible for RTM coverage.

The Food and Drug Administration has approved digital therapeutics, but insurance coverage has remained a problem. Some businesses have pushed for patient pharmacy benefits to pay for their software-based therapies, but AppliedVR is going in a different direction. A new HCPCS (Healthcare Common Procedure Coding System) code that describes the company’s treatment as a virtual reality cognitive behavioral therapy device with pre-programmed therapy software was granted by CMS to the company. The program complied with all five criteria set forth by CMS to qualify as durable medical equipment.

The merit-based incentive payment system (MIPS), which adjusts clinician Medicare Part B payments for performance on quality, cost, improvement activities, and use of certified EHR technology for interoperability, along with EOM quality measurement systems for Medicare, should ideally be meaningful to physicians and patients and coordinated to magnify the quality signal. How do these novel methods compare, then, in terms of genuinely comprehending the standard of cancer care provided to Medicare beneficiaries?