Top 5 Most Popular Reimbursement Content of 2023

Health care costs in the United States are a perennial hot topic, with a protracted push toward value-based contracting, high pricing, and regular reductions in physician payment. This year, the top content included a big change in the largest value-based care program in oncology, a step toward drug price negotiation, and more.

Here are the top 5 pieces of reimbursement content from 2023.

5. Shifting From OCM to EOM: What Stays and What Goes?

The Enhancing Oncology Model (EOM) started July 2023, but before it kicked off, there was great discussion about what the successor to the Oncology Care Model (OCM) and other value-based oncology payment models should look like. At The American Journal of Managed Care^®’s Patient-Centered Oncology Care^® meeting, panelists discussed what elements from the OCM were most successful and needed to be carried over to the EOM, how commercial models can be successful, and billing for chronic care management for patients with cancer. When EOM finally launched, it did so with significantly fewer practices than had been in the OCM.

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4. Physician Groups Mostly Unhappy With Proposed Medicare Fee Schedule

Over the summer, CMS announced its proposed 2024 Medicare Physician Fee Schedule, which would reduce reimbursement by 3.4%. This article, originally published by sister site Medical Economics^®, provided reactions from physician groups, which were largely negative. The president of the American Medical Association was quick to note that in addition to the payment decrease, the inflation rate for medical practice costs had increased from 3.8% in 2022 to 4.5% in 2023. CMS subsequently finalized the 3.4% cut, much to the disappointment to many organizations.

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3. CMS Releases List of 10 Drugs Subject to Price Negotiation Under IRA

Since the Inflation Reduction Act (IRA) was passed into law, the list of 10 drugs CMS would subject to price negotiation was highly anticipated, with many speculating what drugs would make the list. At the end of August, CMS finally released that list, which spanned disease states from diabetes to heart failure to rheumatoid arthritis. Negotiations are taking place now and those prices will ultimately take effect in 2026. According to CMS, from June 1, 2022, to May 31, 2023, the drugs on the list accounted for one-fifth of total Part D–covered prescription drug costs, or approximately $50.5 billion. CMS will also select another 15 drugs for negotiations for 2027 and another 15 for 2028.

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2. Poster Talks Explore How Policy, Payer Incentives Affect Cancer Care, Outcomes

At the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, a group gathered for a session of talks on care delivery and regulatory policy. The session provided talks that focused on 3 related posters. Matthew F. Hudson, PhD, MPH, associate professor of medicine at the University of South Carolina School of Medicine, Greenville, discussed posters involving access to care, and Kerin Adelson, MD, chief quality and value officer at The University of Texas MD Anderson Cancer Center, discussed research initiatives designed to improve patient care and reduce costly and futile end-of-life interventions.

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1. Dr Dennis Scanlon Discusses What to Be Aware of as Medicare Advantage Programs Grow

Medicare Advantage plans are growing in popularity as more seniors choose these plans that they view as offering expanded benefits; however, they sometimes also include more limited provider networks. In this interview, Dennis Scanlon, PhD, professor of health policy and administration, Pennsylvania State University, and editor in chief of The American Journal of Accountable Care^®, discussed a report from the Office of the Inspector General that found some MA plans deny necessary care that should be covered and what might be done to address concerns over denials of services and payment.

Watch the full interview.