Is CMS looking for cost savings in the wrong place?

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Chartreuse Wombat

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"Radiation oncology physician charges represent a small fraction of total Medicare expenses and are not a driver for Medicare spending"
 

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Chartreuse Wombat said:
"Radiation oncology physician charges represent a small fraction of total Medicare expenses and are not a driver for Medicare spending"
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OTN said:
That's a well-done paper which does suggest that targeting radiation oncology with cuts/APM will not move the needle much on overall Medicare spending. I expect to have no (zero) impact on policymaking.
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Unfortunately file all this under “no duh”
 
The a$$ hats making these decisions can't even agree who got the most votes in an election. Even if we made a simple to understand diagram in 1st grade language there is no way they would actually understand the complex issues related to medical expenditures. Even if they could, wouldn't matter. Half want it to be free. The other half need scape goats to go after to convince their constituents they are looking out for them. George Carlin was right. The average person is very dumb. Half of us are dumber than that 🙁
 
This might be the one thing that all of Rad onc, across SDN and twitter could agree on, a whole hearted "YES" in regards to the thread title.

Dum dums and people in the pocket book of pharma are going to continue acting as those two things.
 
also adding 1,000 new CMS-funded residency spots this year!
 
I will love the day when CMS and insurance companies finally wake up and realize that thoughtless use of immunotherapies are the real drivers of spending rather than radiation (even protons, if you're comparing to immunotherapy)
 
FrostyHammer said:
I will love the day when CMS and insurance companies finally wake up and realize that thoughtless use of immunotherapies are the real drivers of spending rather than radiation (even protons, if you're comparing to immunotherapy)
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Hopefully it will be before we eliminate or take everyone down to one fraction or less.
 
All of this is not rad onc specific. This is all part of the Medicare access and CHIP reauthorization act of 2015 or MACRA that created the Medicare Quality Payment Program. This requires quality based payment program with Medicare participates to improve care across the entire health care delivery system including merit based incentive payment systems or advanced alternate payment models. The house passed this with a 392-37 vote and the Senate with 92-8 vote with bill being signed by Obama in 2015.

The goal of the act was to achieve healthcare payment reform by linking Medicare payments to quality/value. The legislation says a certain proportion of patients or payments must be made through APM as the years go by.

Just saying that rad onc is not a large driver of and is only a small fraction of total medical cost is completely irrelevant to what was passed and to what is being implemented. These changes are coming no matter what is the bottom line. It is mandated by official law and is not just some vague zero sum lets lower cost policy.

I am not saying I am personally a fan of all of this but just wanted to state what the reality is.
 
fiji128 said:
Just saying that rad onc is not a large driver of and is only a small fraction of total medical cost is completely irrelevant to what was passed and to what is being implemented. These changes are coming no matter what is the bottom line. It is mandated by official law and is not just some vague zero sum lets lower cost policy.
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Except to big pharma?
 
fiji128 said:
All of this is not rad onc specific. This is all part of the Medicare access and CHIP reauthorization act of 2015 or MACRA that created the Medicare Quality Payment Program. This requires quality based payment program with Medicare participates to improve care across the entire health care delivery system including merit based incentive payment systems or advanced alternate payment models. The house passed this with a 392-37 vote and the Senate with 92-8 vote with bill being signed by Obama in 2015.

The goal of the act was to achieve healthcare payment reform by linking Medicare payments to quality/value. The legislation says a certain proportion of patients or payments must be made through APM as the years go by.

Just saying that rad onc is not a large driver of and is only a small fraction of total medical cost is completely irrelevant to what was passed and to what is being implemented. These changes are coming no matter what is the bottom line. It is mandated by official law and is not just some vague zero sum lets lower cost policy.

I am not saying I am personally a fan of all of this but just wanted to state what the reality is.
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Just saying that rad onc is not a large driver of and is only a small fraction of total medical cost is completely irrelevant to what was passed and to what is being implemented.

I am not sure it is irrelevant. Do you know of any other MANDATORY APMs other than RO-APM (which thankfully has been pushed back)?

The original language in the language that required a report to CMS was super specific and only listed RO. Highlighted in the attachment.

Isn't that odd?
 

Attachments

Chartreuse Wombat said:
Just saying that rad onc is not a large driver of and is only a small fraction of total medical cost is completely irrelevant to what was passed and to what is being implemented.

I am not sure it is irrelevant. Do you know of any other MANDATORY APMs other than RO-APM (which thankfully has been pushed back)?

The original language in the language that required a report to CMS was super specific and only listed RO. Highlighted in the attachment.

Isn't that odd?
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Not really an expert or even aware of what’s going on in other specialties in regards to this but this is from the ama.


Opportunities to improve care and reduce spending​

There are a number of areas where physicians can look to find ways to improve care for patients that can also help reduce spending for payers and out-of-pocket costs for patients.

The following are examples of work currently underway by specialty societies to develop APMs for several patient conditions.

Angina (Stable)​

For the specialties of cardiology and primary care, opportunities include:

  • Help patients quickly and accurately determine the causes of chest pain and their risk of a heart attack
  • Reduce unnecessary use of stress tests and cardiac imaging
  • Reduce unnecessary invasive cardiac tests and procedures
  • Reduce the risk of heart attacks

Asthma​

For the specialties of allergy and immunology, opportunities include:

  • Improve diagnostic accuracy, treatment planning and medication adherence
  • Reduce work and school absenteeism and increase productivity
  • Reduce emergency visits and hospitalizations due to asthma exacerbations

Cancer​

For the specialties of medical oncology, pathology, radiation oncology and surgical oncology, opportunities include:

  • Improve cancer outcomes through accurate diagnosis and staging, as well as appropriate use of treatments
  • Help cancer patients in managing psychological, physical and financial challenges of their disease
  • Reduce nausea, vomiting, pain, dehydration and other complications of cancer
  • Reduce complications requiring emergency visits and hospital admissions
  • Improve appropriateness of imaging during surveillance for progression and recurrence of disease

Chronic Kidney Disease​

For the specialties of nephrology and vascular surgery, opportunities include:

  • Slow progression to end stage renal disease and improve treatment planning
  • Plan ahead for hemodialysis patients' vascular access to create and maintain arteriovenous fistula and avoid use of multiple catheters
  • Avoid emergency visits and hospitalizations

Diabetes​

For the specialties of endocrinology and primary care, opportunities include:

  • Reduce complications and associated hospitalizations
  • Prevent or slow disease progression from pre-diabetes and diabetes
  • Improve patient understanding and self-management of their condition

Epilepsy​

For the specialty of neurology, opportunities include:

  • Improve accuracy of diagnosis
  • Reduce frequency and severity of seizures
  • Reduce injuries and complications requiring emergency visits and hospitalizations

Ovarian and Endometrial Cancer​

For the specialty of gynecologic oncology, opportunities include:

  • Improve outcomes of cancer treatment through more accurate diagnosis and appropriate treatment
  • Reduce repeat surgeries and readmissions
  • Avoid unnecessarily invasive surgery and reduce complications of surgery

Pregnancy​

For the specialties of obstetrics and gynecology, opportunities include:

  • Reduce elective early deliveries and use of elective C-sections
  • Reduce low birthweight deliveries and need for neonatal ICU care
  • Reduce complications of delivery
  • Deliver babies in lower-cost settings

Stroke​

For the specialties of neurology, radiology, physical medicine and rehabilitation, primary care, and vascular surgery, opportunities include:

  • Get rapid and accurate diagnosis
  • Improve coordination and reduce fragmentation
  • Return patients to maximum functionality
  • Use the most cost-effective facilities and services for rehabilitation
  • Prevent additional strokes
 
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fiji128 said:
looks like at least renal has there own as well.

TechTarget Enterprise Technology News | Health IT

revcycleintelligence.com revcycleintelligence.com

definitely not rad onc specific

www.psychiatry.org

Advanced Alternative Payment Models

Psychiatrists, other physicians, and non-physician practitioners may qualify for Medicare payment incentives for participating in new models of care and delivery that improve quality, lower health care spending, or both.
www.psychiatry.org www.psychiatry.org
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These are voluntary programs. Not MANDATORY from CMS.

Most all of the voluntary programs are failures (at least that is what the CMS guru said early last year). I am rephrasing but she said the only way we get cost savings is to mandate.
 
Chartreuse Wombat said:
These are voluntary programs. Not MANDATORY from CMS.

Most all of the voluntary programs are failures (at least that is what the CMS guru said early last year). I am rephrasing but she said the only way we get cost savings is to mandate.
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The renal one is also mandatory ( in certain regions as well) so both specialities will be first in the shooting line for this for whatever reason (maybe b/c we are so small and lack lobbying clout) but it’s seems like it’s will eventually rolled out in other specialities as well.
 
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Chartreuse Wombat said:
Just saying that rad onc is not a large driver of and is only a small fraction of total medical cost is completely irrelevant to what was passed and to what is being implemented.

I am not sure it is irrelevant. Do you know of any other MANDATORY APMs other than RO-APM (which thankfully has been pushed back)?

The original language in the language that required a report to CMS was super specific and only listed RO. Highlighted in the attachment.

Isn't that odd?
Click to expand...
Didn't hospitals go apm awhile ago with the DRG stuff? I heard ortho is sort of like that as well maybe with joint replacements? Apm could work in med onc, but big pharma lobbyists will not let it happen I'd imagine
 
I really have no idea outside of rad onc in terms of specifics. It’s clear that CMS wants to go down this route but pharm lobby and specifically onc pharm lobby is a 800 lbs gorilla that will give every Congress person max allowed $ so it doesn’t touch their revenue.
 
Yeah,

This country political system is corrupted, money talks, pharma talks.
The main cost is in med onc. If gov wants to save money, they need to look into med onc.
 
medgator said:
Didn't hospitals go apm awhile ago with the DRG stuff? I heard ortho is sort of like that as well maybe with joint replacements? Apm could work in med onc, but big pharma lobbyists will not let it happen I'd imagine
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Yeah they did in the 80s and look what happened to them. Dropping like flies.
 
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