Payment Reform

The announcement in February of a new Oncology Care Model has brought a lukewarm response by the American Society of Clinical Oncology (ASCO). Developed by the Centers for Medicare & Medicaid Services (CMS) Innovation Center and announced through the US Department of Health & Human Services, the new care delivery model encompasses a multipayer structure as well as incentivized and monthly per beneficiary payments to participating practices. Read More ›

Once again, providers and practice administrators are in limbo about the status of Medicare payments. In late March, Congress moved closer than they ever had before, but stopped just short of repealing and replacing Medicare’s sustainable growth rate (SGR) physician payment formula. Read More ›

The announcement in February of a new Oncology Care Model has brought a lukewarm response by the American Society of Clinical Oncology (ASCO). Developed by the Centers for Medicare & Medicaid Services (CMS) Innovation Center and announced through the US Department of Health & Human Services, the new care delivery model encompasses a multipayer structure as well as incentivized and monthly per beneficiary payments to participating practices (see article on this page). Read More ›

Cancer care expenditures in the United States are staggering, and are only expected to climb. In 2010, the total cost of cancer care was $125 billion. By 2020, with more individuals living with cancer as a chronic disease, costs are expected to grow by 39% and exceed $170 billion. Faced with this dramatic escalation of costs, providers, commercial payers, and the government are testing different methodologies for reimbursing cancer care. The aim is to shift the economics from a fee-for-service environment (ie, buy and bill) to one that rewards quality, efficiency, and a lower cost of care. Read More ›

A new payment model announced by the US Department of Health & Human Services offers providers the potential to receive at least $160 per month for patients who are undergoing chemotherapy treatment. The per-beneficiary, per-month (PBPM) allocation is part of a 2-pronged approach that also includes a performance-based payment to incentivize practices to reduce costs and improve care for this patient population. Read More ›

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