Reimbursement

With so many different oncology alternative payment models (APMs) available, choosing the right ones to participate in might simply mean finding which ones already align with what a practice is doing, said Amy Ellis, chief quality officer at Northwest Medical Specialties.

Amid recent reforms on price transparency by CMS and the Trump administration, payers' workloads will substantially increase with notable challenges that include having to maintain accurate prices and the impact of exposed negotiated rates.

The US Surgeon General, Vice Admiral Jerome Adams, MD, and other officials urged for greater uptake of FDA-approved treatments for coronavirus disease 2019 (COVID-19) in an effort to slow the surge of cases requiring hospitalization. However, logistic, monetary, and efficacy concerns may have drastically limited the amount of biologic treatments actually administered to patients.

The statement is aimed at drug companies, policymakers, pharmacy benefit managers, employers, and others, and calls to attention soaring insulin costs, which were the subject of several Congressional hearings in 2019.

Barbara McAneny, MD, founding partner of New Mexico Oncology Hematology Consultants, discusses why putting risk on oncologists is not the way to fix cost issues in cancer care.

The coronavirus disease 2019 (COVID-19) pandemic disrupted many mental health services for children; a study on the long-term effects of COVID-19 will soon kick off; a $13-billion deal has been struck for UnitedHealth to buy Change Healthcare.

The economics of cancer care remain a major concern as practices try to figure out how to deal with the cost of providing cancer care, said Sibel Blau, MD, medical oncologist, Northwest Medical Specialties, and president and CEO, Quality Cancer Care Alliance (QCCA).

Barbara McAneny, MD, CEO of New Mexico Oncology Hematology Consultants, gives her insight on the potential pitfalls of bundled payment plans in oncology and how they could potentially work.

There is a lot of variation among commercial payers, but broadly speaking they are expected to start moving to adopt what Medicare does, said Basit Chaudhry, MD, PhD, founder of Tuple Health.

Home administration of oral paclitaxel and encequidar is associated with potential cost savings for payers compared with clinic administration of intravenous chemotherapy in metastatic breast cancer patients.

Home administration of oral paclitaxel and encequidar is associated with potential cost savings for payers compared with clinic administration of intravenous chemotherapy in metastatic breast cancer patients.

An advisory panel recommends who should receive the next doses of a coronavirus disease 2019 vaccine; bipartisan legislation includes measures to curb surprise medical billing; Tennessee faces virus surge.

The use of Mohs micrographic surgery, which had the highest average Medicare payment from 2012-2017 among a set of 4 skin cancer procedures, has increased by more than 20%.

The COVID-19 pandemic has impacted specialty practices generally and oncology practices especially have been resilient throughout the pandemic.

Barbara McAneny, MD, CEO of New Mexico Oncology Hematology Consultants, discusses the issues with placing risk on oncologists as they work to provide quality care to patients.

FDA regulators find Moderna's experimental coronavirus disease 2019 (COVID-19) vaccine safe and effective; 27 states and the District of Columbia are asking HHS to step in regarding drug companies restricting access to 340B pharmaceuticals; pandemic worsens food insecurity in America.

In its 2021 Hospital Outpatient Prospective Payment Final Rule, CMS announced it will delay its radiation oncology payment model from January 2020 until July 2021.

There are certain adjustments that CMS can make to Oncology Care First (OCF) during the delay that CMS is already doing successfully in other alternative payment models, said Mike Fazio, at Archway Health.

During a period of rapid fluctuation in the intravenous iron market, there was increased use of a more expensive drug that afforded providers additional revenue.

Incorporating data from functional status assessments, we developed a Medicaid payment model for long-term services and supports in a community-dwelling population of older adults.

This study compared beneficiary characteristics and Medicare per capita expenditures among seriously ill Medicare accountable care organization (ACO) populations defined using prospective and retrospective claims-based attribution methods.

Delayed care due to the coronavirus disease 2019 pandemic has created a lot of uncertainty around alternative payment models (APMs) like the Oncology Care Model (OCM), said Basit Chaudhry, MD, PhD, founder of Tuple Health.

There are ways practices can take advantage of the delay of Oncology Care First (OCF) to continue learning from their experience in Oncology Care Model (OCM), said Mike Fazio, of Archway Health.

An analysis published in Health Affairs outlines the benefits of structuring negotiations and standardizing fee-for-service payments independent of any specific reform proposals to control health care spending in 3 high-income countries.

The coronavirus disease 2019 (COVID-19) pandemic is going to test the new risk adjustment in the Oncology Care Model as patients delay care, said Mike Fazio, senior vice president of Client Services at Archway Health.

President Donald Trump issued 2 orders Friday aiming to lower drug prices paid by Medicare by invoking a "most favored nations" policy and also by targeting rebates paid to pharmacy benefit managers.

A discussion of the final Radiation Oncology Model; after this article went to press, CMS announced a delay until July 2021, reflecting concerns of radiation oncologists.

COVID-19 has created a significant distraction from normal practice operations. The uncertainty that comes along with the pandemic is a huge worry, and can distract from practice transformation.

COVID-19 has delayed the transition to Oncology Care First, but the forthcoming model could help.

CMS Administrator Seema Verma announced the update today in a blog post in Health Affairs.