340B...Unintended consequences?

[Chartreuse Wombat]

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http://www.nejm.org/doi/full/10.1056/NEJMp1716139?query=TOC

Discuss!

 

[Gfunk6]

If you have spiraling, out-of-control drug costs from US Pharma/Biotech then it is quite clear that CMS will never be able to cost contain without ability to NEGOTIATE PRICE. Unless this is done (and our current HHS secretary is adamantly against it - Trump's pick to head HHS balks at having government negotiate drug prices) then costs will continue to rise.

It's pretty clear that this dog-and-pony show called MIPS/MACRA won't do jack except force doctors to do what they've always been doing yet click a bunch of checkboxes and pay a ton of money into a self-sustaining combined private and government bureaucracy.

 

[medgator]

It's interesting how the 340b program is essentially being justified by hospitals as a subsidy to help offset their losses from other hospital activities. And AFAIK, the drug companies take the hit when it comes to providing the cheaper pricing on these drugs which are used on well-insured patients at these hospital-owned infusion centers.

So essentially drug companies are taking a hit to help hospitals better deal with their own money-losing operation.

 

[RickyScott]

Major argument against the 340B system: Hospitals could earn significantly more dispensing chemo than outpt centers. Therefore, many community medonc practices folded into/purchased by hospitals (medonc makes more employed by hospitals than in own practice) so, now patients are shifting from low to high cost centers!
Program ends up costly to society.


In turn, with radiation: main campus establishes purchases/satellites/ or takes over community hospital departments and now fleeces the community with monopolistic rates. Put another way, when large academic centers sow lots of sattellite centers, they are not trying to save society money with cost effective radiation. (trust me, they do not take "choose wisely" to heart.

 

[medgator]

Fresh out of nejm...

http://www.nejm.org/doi/full/10.1056/NEJMsa1706475?query=TOC

Program eligibility was associated with lower proportions of low-income patients in hematology–oncology and ophthalmology and with no significant differences in hospital provision of safety-net or inpatient care for low-income groups or in mortality among low-income residents of the hospitals’ local service areas.

The 340B Program has been associated with hospital–physician consolidation in hematology–oncology and with more hospital-based administration of parenteral drugs in hematology–oncology and ophthalmology. Financial gains for hospitals have not been associated with clear evidence of expanded care or lower mortality among low-income patients.

 

[medgator]

In the 2019 HOPPS proposed rule, CMS continues to express concern regarding the continued growth in Medicare expenditures for hospital outpatient services paid under the HOPPS. While changes required by section 603 of the Bipartisan Budget Act of 2015 address some of the Agency’s concerns related to shifts in sites of care and overutilization in the hospital outpatient setting, CMS remains concerned that the majority of hospital outpatient departments continue to receive full HOPPS payment. Full HOPPS payment is often higher than payment for a similar service furnished in a physician office setting.

To address this issue, CMS is proposing to cap the HOPPS payment at the MPFS rate for clinic visits as described by G0463, regardless of whether the PBD delivering the service met the “excepted” status as implemented in 2017. CMS believes this is an effective way of controlling the volume of unnecessary services delivered in higher cost settings. The Agency estimates that this proposal will save Medicare $760 million in the first year.

Proposed Hospital Outpatient Prospective Payment System - American Society for Radiation Oncology (ASTRO)

 

[Gfunk6]

Damn Gator, you beat me to it!