From the Editor
Dramatic Reimbursement Changes Coming: SGR Is Out and MACRA Is In, but It Will Not Be Easy for Practices
When the federal Sustainable Growth Rate (SGR) rollercoaster ended in repeal, physicians across the country sighed with relief. There would be no more waiting for Congress to modify the automatic double-digit reductions that the annual SGR calculations threatened. However, the reality of the new reimbursement adjustments looming from the legislation that replaced the SGR, now known as MACRA (Medicare Access and Children’s Health Insurance Program Reauthorization Act), is right around the corner.
Just when you thought grade school and report cards were a distant memory, here comes a loud wake-up call. Report cards and grading systems are now (or soon will be) very visible parts of our future as healthcare providers. We may create the scores ourselves, publicize rankings we earn, or be judged by rankings that others place on us. The implications of these new grading systems are going to be significant for our business volume and for the payments we receive for the care being delivered.
Now that ICD-10 has become a reality, oncology practices are still going to face uncertain income, unready payers, delays in payment, and possible take-backs of paid monies following audits after the fact.
June 30, 2015, was the deadline for submission of practice-based applications to the Center for Medicare and Medicaid Innovation (CMMI) for the Oncology Care Model (OCM). The dust has settled. Those who were going to apply have done so, and those who decided not to, have watched the hustle and bustle during June with some amusement.
If your practice or cancer center receives, handles, stores, compounds, dispenses, administers, or disposes of hazardous drugs, you may soon be affected by the US Pharmacopeial Convention’s General Chapter 800 Hazardous Drugs—Handling in Healthcare Settings (USP 800). It will affect different practices in different ways, depending on how it is enforced as well as the agency or organization that may choose to enforce it.
The federal government is determined to shift Medicare’s traditional fee-for-service plans into alternative quality-based or value-based payment programs. Currently more than 400 accountable care organizations (ACOs) and more than 100 hospitals and other healthcare groups accept Medicare bundled payments, but they are predominantly focused on primary care.
No matter how high you want to go, you have to step on that first rung of the ladder. Every oncology practice in the country is making plans to move forward in some direction, and will have to climb a ladder, one step at a time.
Our inboxes are overflowing with news of the Oncology Care Model (OCM) that was announced by the US Department of Health & Human Services on February 12. Full details are being unveiled regarding this bundled payment model, which was developed by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, and practices are starting to assess the expectations of the program versus the risks and rewards of participation or a decision not to participate.
I was disturbed recently after reading a news report in which the head of a large pharmacy benefit manager (PBM) stated the company’s intentions to eventually start influencing the price of oncology drugs as well as extend its management, oversight, and influence to cancer drugs administered in doctors’ offices and hospitals. Meetings have already begun with top oncologists, according to the company leader who was interviewed, and the company is looking to find ways to eventually guide doctors toward preferred drugs in the PBM’s approved formulary in ways that do not cause patients to be upset.
Those who care for patients with cancer are special. Clinical team and staff members come to work daily not just for a job, but because they care and want to be a part of helping their friends, neighbors, and community battle an insidious disease. Most of us have loved ones who were touched by cancer, and we bring unique, appreciated, and caring attention to those who we serve.
Page 2 of 5
Results 11 - 20 of 48
Results 11 - 20 of 48