Radiation Oncology Models of Care: Savings for Providers
Wednesday, October 30, 2019 | by Randy Haught
On July 18, 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a payment model that would make prospective episode-based payment for a list of specified professional and technical radiation therapy (RT) services furnished during a 90-day episode to Medicare fee-for-service (FFS) beneficiaries diagnosed with one of 17 cancer types. This issue brief - the third in our series of "Radiation Oncology Episodes of Care"- shows that the newly proposed CMS payment model may present savings opportunities for radiation therapy providers.
Radiation Oncology Model Episodes of Care: Cost Differences Across Treatment Modalities
Monday, October 14, 2019 | by Randy Haught
CMS proposed a prospective payment model that would pay participating hospital outpatient departments (HOPD) providers and freestanding radiation therapy centers for radiation therapy (RT) episode-based payment for a list of specified professional and technical RT services furnished during a 90-day episode to Medicare fee-for-service (FFS) beneficiaries diagnosed with one of 17 cancer types. Providers will be paid a single rate for each specific cancer type regardless of the treatment modality (i.e., stereotactic radiosurgery, intensity-modulated radiotherapy, conventional external beam, intraoperative radiotherapy, proton beam therapy, or brachytherapy) selected for the patient. Technical component providers that will be subjected to the Radiation Oncology (RO) payment model will need to determine how to achieve a 5-percent savings, which is CMS discount from average historical spending. One option will be to assess the clinical appropriateness and cost effectiveness of the treatment modality used during the episode. This blog is the second in the multi-series of blogs titled "Radiation Oncology Episodes of Care" and examines the cost differences across the various treatment modality options and their impact on episode spending.
Radiation Oncology Model Episodes of Care: Analyzing Medicare Spending
Monday, September 30, 2019 | by Randy Haught
On July 18, 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a payment model that would make prospective episode payments to hospital outpatient departments (HOPD) and freestanding radiation therapy centers for radiation therapy (RT) episodes of care. The model will be mandatory for a sample of RT providers and suppliers and is specific to core-based statistical area (CBSAs), which have not yet been determined. Medicare would pay participating providers and suppliers a site-neutral, episode-based payment for a list of specified professional and technical RT services furnished during a 90-day episode to Medicare fee-for-service (FFS) beneficiaries diagnosed with one of 17 cancer types. This blog is the first in the multi-series of blogs titled "Radiation Oncology Episodes of Care" and takes a look the historical Medicare payments for radiation therapy.
Challenges for Rural Healthcare
Friday, August 30, 2019 | by Steven Heath
The Center for Medicare and Medicaid Services (CMS) recently proposed changes in the way Medicare payments for inpatient hospital visits are made through changing wage index calculations. In the proposed 2019 notice of public rulemaking (NPRM), CMS proposes two solutions to address th Medicare national standardized payments to account for differences in market area labor costs across the country. This blog discusses the implications of the NPRM for hospitals in rural areas.
BPCI Advanced Participation Decisions in March 2019
Monday, March 25, 2019 | by Randy Haught
Last August CMS provided a one-time retroactive opportunity to withdraw in total from the BPCI Advanced program or withdraw selected clinical episodes by March 1, 2019. This grace period allowed participants to “test the waters” between October 2018 and February 2019 before making a final decision. Participants that retroactively withdraw in total or for select clinical episodes are not held accountable for those episodes, meaning that any losses incurred relative to the established target prices will not be charged to the bundler.
Pathways to Success Implementation Offers ACOs Greater Risks and Rewards
Wednesday, February 27, 2019 | by Alex Hartzman
The Medicare Shared Savings Program (MSSP) is undergoing a major overhaul under the Pathways to Success regulation, finalized December 31, 2018. This regulation replaces the existing program participation tracks with an emphasis on increasing downside risk, as well as updates a variety of other program rules. This rule went into effect on January 1, 2019, with most aspects to be implemented fully starting July 1, 2019.
Is It Time for a Mid-Course Correction for Medicaid DSH?
Wednesday, February 27, 2019 | by Joan DaVanzo
The Patient Protection and Affordable Care Act (P.L. 111-148 as amended) required significant reductions to Medicaid payments to hospitals that serve a disproportionate share (DSH) of low-income and vulnerable patients starting in 2014. However, the start of Medicaid DSH payment cuts was delayed several times by policymakers. In 2013, Congress postponed the beginning of payment reductions to 2018, and budget bills in later years continued to postpone the cuts.
BPCI Advanced Grace Period is Coming to a Close
Monday, February 25, 2019 | by Randy Haught
Last August the Centers for Medicare and Medicaid Services (CMS) provided a one-time retroactive opportunity to withdraw in total from the BPCI Advanced program or withdraw selected clinical episodes by March 1, 2019. This grace period allowed participants to “test the waters” between October 2018 and February 2019 before making a final decision. Participants that retroactively withdraw in total or for select clinical episodes will not be held accountable for those episodes. Meaning that any losses incurred relative to the established target prices will not be charged to the bundler.