Payment and Delivery Reform
Brave New World: Medicare’s Advanced Payment Models
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established a new framework for Medicare physician payment. Under the law, beginning in 2019, health care professionals participating in the program will come to a crossroads on their path to reimbursement. In one direction—the default direction—they will be subject to the Merit-Based Incentive Payment System (MIPS), a revamp of Medicare’s fee-for-service (FFS) payment system that consolidates existing quality programs into a unified reimbursement component....
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Moops?: A Roadmap To MIPS
After a seemingly endless stream of stop-gap “doc fixes,” President Obama on April 14, 2015, signed into law a permanent repeal and replacement of Medicare’s Sustainable Growth Rate formula. The 2015 law, known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10), permanently reformed Medicare physician payments and (finally) put to rest what had become a dreaded perennial legislative ritual of blocking reimbursement cuts. ...
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Implementation Of The Biosimilars Provisions Of The ACA — Where Are We Now?
Despite the passage of a 2010 law addressing such medicines, the Food and Drug Administration’s (FDA) approval this year of the first biosimilar has prompted a flurry of regulatory activity aimed at filling gaps left by the statute. For a helpful primer on the issue, see a recent Health Affairs Health Policy Brief. This post will address key concerns raised by recent FDA guidance, as well as other widely anticipated but yet-to-be released regulatory activity, such as the pivotal interchangeability standard....
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Review Of Proposed 340B Omnibus Guidance: How We Got Here And What It Says
In a previous post—now almost one and a half years ago—I described “the coming storm” I anticipated would develop around the 340B drug discount program. After a brief tornado hit the House Energy and Commerce Committee when they considered including 340B reforms in their 21st Century Cures initiative, a slower, hurricane-style churn over the Administration’s proposed guidance on the topic has settled in....
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May The Era Of Medicare’s Doc Fix (1997-2015) Rest In Peace. Now What?
After seventeen years (eight months, 9 days…), over a dozen acts of Congress and innumerable reams of debate and conjecture about its fate, it’s time to say goodbye to the Medicare Sustainable Growth Rate (SGR) formula. As a proper wake, let’s take a moment to reflect on this enigma of health care economic theory. And then let’s not ever do it again....
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Unpacking the Doc Fix
If you blinked on Thursday, you might’ve missed the House passing the latest Medicare’doc fix’ After posting the bill in the wee hours of Wednesday morning, House leaders faced opposition over its stop-gap approach and some of the cuts employed to offset the cost of the bill. With some arm-twisting, they managed to suppress objections for the handful of seconds necessary to hammer the gavel and call it done....
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Unpacking the Wyden Chronic Care Bill
As he ascends to the Chair of the Senate Finance Committee, Senator Ron Wyden’s recent proposal to reform Medicare by improving care for the chronically ill has garnered significant attention and support. Its topline goal of incentivizing integration of care for high-risk patients is resonating with stakeholders across the health care continuum....
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