Articles related to MEDICARE

The recent proposal by CMS to cut radiation therapy reimbursement by 2% in 2024 has led to serious concerns among radiation oncology specialists. With cumulative reductions reaching 20% over the past decade, the potential impact on patient access, especially in rural areas, and the perceived devaluation of the field are urgent issues that call for thoughtful consideration and response.

The recent study exploring the Mark Cuban Cost Plus Drug Company’s potential impact on Medicare’s oncology drug spending uncovers significant savings opportunities. Physicians may find interest in this model’s potential to improve access to essential cancer medications through reduced costs, emphasizing a call to examine current overpayment within the Medicare system.

The potential removal of the DIEP flap’s unique medical billing code by CMS could pose significant barriers to this beneficial breast reconstruction option, prompting calls for its preservation to ensure continued access and patient choice. Dive in to explore the implications of this pivotal issue for breast cancer patients and the health care system.

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.

Community oncologists in the United States are at risk of violating the Stark Law if they continue to mail or use delivery services to ensure their patients have access to essential oral medications, after the COVID-19 public health emergency (PHE) ends on May 11th. The Stark Law is a federal law that prohibits healthcare providers from referring patients to entities with which they have a financial relationship, unless certain exceptions apply. The FAQ document published by the Centers for Medicare & Medicaid Services (CMS) in September 2021 suggests that mailing oral drugs could violate the Stark Law, even if the practice does not receive any financial benefit from the delivery. This interpretation is so broad that it could also bar relatives or caregivers from picking up patients’ medications. As a result, practices are facing a difficult choice: require patients to pick up medications in person or refer them to third-party mail-order pharmacies. The latter could lead to delays, denials, or sometimes errors because of a lack of direct communication between the pharmacy and physician.