Reimbursement

Medicare’s upcoming health equity adjustment in the Hospital Value-Based Purchasing (HVBP) program will reduce disproportionate penalization among safety net hospitals and those serving high proportions of Black patients, according to a recent study.

Al Benson, MD, FACP, FACCC, FASCO, medical oncologist at Northwestern University Feinberg School of Medicine and associate director of the Robert E. Tillery Comprehensive Cancer Center, discussed findings from a national survey assessing barriers to comprehensive cancer care delivery.

As pressure from the Biden administration on UnitedHealth Group increases, physicians' groups weigh in following the unprecedented hack on Change Healthcare.

During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.

An appeals court rules against the Pharmaceutical Research and Manufacturers of America in a 340B contract pharmacy dispute; for-profit investors’ acquisition of nursing homes has raised concerns about the quality of care provided in these facilities; President Joe Biden’s proposed budget for 2025 includes changes that would do away with the current system of biosimilar interchangeability.

The author calls on Congress to address reimbursement shortfalls that are contributing to a growing physician shortage, with rural areas the hardest hit.

In his State of the Union Address, the president called for expanding the number of drugs subject to Medicare price negotiations and extending a $2000 out-of-pocket cap beyond seniors.

A new federal rule will provide higher Medicare payments for homeless patients, which may encourage hospitals to identify these patients and help them with their needs.

Appeals court to review ruling wiping out some cost-free preventative services; a new legislation aims to boost reimbursement rates for medical providers; changes to coverage may limit elderly home care access

The Community Oncology Alliance (COA), which represents independent cancer care practices, has asked CMS to act following a dramatic drop in reimbursements from Express Scripts, Inc. effective January 1, 2024.

While adopting new payment models can come with challenges, there are strategies that can help oncology practices optimize their approaches, said Kathy Oubre, MS, CEO of Pontchartrain Cancer Center.

From an interview conducted during Patient-Centered Oncology Care 2023.

Over the past 20 years, Medicare physician pay has plummeted by 26% when adjusted for inflation, while hospital reimbursement has surged by 70%, prompting over 100,000 doctors to abandon independent practice for hospital or corporate employment since 2019.

UnitedHealthcare is incorporating real-world evidence into pathways design and policy formulation, leveraging its members' data to evaluate the impact of different regimens on health resource utilization and costs, explains Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare.

The authors call on Congress to reform Medicare reimbursement for dialysis, saying the recent rule puts clinics at risk of closure.

The author, chair of the Government Affairs Committee with the American College of Rheumatology, calls for support for efforts in Congress to reform the Physician Fee Schedule.

The most popular reimbursement content of 2023 included coverage of the shift from the Oncology Care Model to the Enhancing Oncology Model, reactions to the 2024 Medicare Physician Fee Schedule, and concerns around denial of services in Medicare Advantage plans.

While the Enhancing Oncology Model is the successor of the Oncology Care Model, it includes some very real challenges for participating practices, explained Lalan Wilfong, MD, senior vice president of payer and care transformation at The US Oncology Network.

In 2023, the most-read articles published in The American Journal of Accountable Care® (AJAC) highlighted innovative care models, lessons learned from health system partnerships, and much more.

In 2023, the most-read articles published in the peer-reviewed The American Journal of Managed Care® (AJMC®) explored predictive models, opioid prescribing, and much more.

Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.

A one-size-fits-all approach to alternative payment models (APMs) often isn’t very fair to community practices, said Miriam Atkins, MD, FACP, president of the Community Oncology Alliance.

Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.

Initiative aims to enhance maternal health and birth outcomes; Wegovy success will help fund a vaccines initiative for respiratory diseases; new tactics aim to remove abortion from the 2024 ballot

Top coverage from the National Association of Managed Care Physicians (NAMCP) Spring Managed Care Forum 2023 included sessions on value-based care implementation and best treatment practices.

The bipartisan bill would help lower Medicare costs and improve quality of care, according to the National Association of ACOs.

Activity to regulate pharmacy benefit managers (PBMs) has started in the states and is trickling up to the federal level, said Ted Okon, MBA, executive director of the Community Oncology Alliance.