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In August, the Health Resources and Services Administration (HRSA) released its much-anticipated “mega-guidance” on the 340B Drug Pricing Program, proposing new limits on the program but stopping short of a complete overhaul, which prompted mixed reviews from healthcare stakeholders. The Association of Community Cancer Centers (ACCC) has long advocated for more clarity in the program, and we commend HRSA for taking this important step amid legal challenges and congressional pressure.
End-of-life planning and care have received a lot of attention in recent months. In exploring ways to increase the value of healthcare both in terms of patient satisfaction and cost benefits, health policymakers have zeroed in on end-of-life care expenditures. The Centers for Medicare & Medicaid Services (CMS) has found that over 25% of Medicare healthcare spending can be attributed to 5% of Medicare beneficiaries who die annually. The goals of policymakers who are pushing for care planning are to identify a patient’s end-of-life preferences early, and to ensure that subsequent care aligns with these wishes.
States have long been recognized as incubators for new policy models, and health policy is no exception. We have seen a multitude of approaches to health insurance and delivery taken up by states after the passage of the Affordable Care Act (ACA). States have chosen to create their own exchanges, defaulted to the federal exchange, or opted for a middle ground with state partnership and federally supported exchanges.
As most state legislatures adjourn from their 2015 session, we have begun to reflect on key policy trends emerging this year. In terms of policy impacting cancer care, efforts to limit patient exposure to rising drug costs and maintain access to potentially life-saving treatments have continued to grow, and we are seeing an increase in the number of bills introduced by state legislators and the number of policy approaches regarding these issues. Although there was a focus on achieving oral chemotherapy parity over the past several years, we now see broad proposals to cap copays, limit the use of specialty drug tiers, and limit the use of step therapy.
On April 14, 2015, after years of uncertainty and 17 short-term “doc fix” patches to prevent severe annual cuts to physician reimbursement payments, Congress approved the Medicare Access and CHIP Reauthorization Act (MACRA), bringing an end to the Medicare sustainable growth rate (SGR). This bipartisan, bicameral compromise will provide physicians with the predictability in payments needed to continue to provide high-quality cancer care, while transitioning over a 10-year period to a new Medicare reimbursement system.
Recent months have brought unprecedented momentum on an issue physicians and Congress have been struggling with for more than a decade: repealing the sustainable growth rate (SGR) formula.
On February 12, the US Department of Health & Human Services announced its much-anticipated Oncology Care Model, developed by the Centers for Medicare & Medicaid (CMS) Innovation Center as part of the broader effort to lower healthcare costs and tie reimbursement to quality and value. The Association of Community Cancer Centers has been conducting an in-depth analysis, and the model generally looks similar to the discussion draft made available in August last year; although the model contains many positive elements, many questions still remain.
On February 12, the US Department of Health & Human Services announced its much-anticipated Oncology Care Model, developed by the Centers for Medicare & Medicaid (CMS) Innovation Center as part of the broader effort to lower healthcare costs and tie reimbursement to quality and value.
There has been renewed focus in recent years on moving healthcare reimbursement from a system that incentivizes volume to one that incentivizes value. Largely an effort to rein in costs, particularly those related to Medicare, this trend has cropped up in every major healthcare law in the past decade, from the Medicare Modernization Act in 2003 to the Patient Protection and Affordable Care Act (ACA) in 2010. In fact, the ACA allocated $10 billion to the new Center for Medicare & Medicaid Innovation, whose purpose is to develop and test innovative ways to pay providers. Even last year’s bipartisan, bicameral sustainable growth rate legislation ultimately tied payment updates to participation in some form of alternative payment arrangement.
The 2014 elections are complete, and we now know the makeup of the next US Congress. Even though Republicans picked up more than the 6 seats needed to take control of the Senate, it may not mean that significant healthcare changes are imminent. As the congressional landscape transforms, legislators will have to address the following issues.
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