CMS May Boost Medicare Payments For Breakthrough Treatments As ‘Antiquated System’ Hasn’t Kept Up With Developments
In particular, CMS Administrator Seema Verma said the agency was considering boosting reimbursements for a customized approach called CAR T-cell therapy, which has revolutionized the treatment of hard-to-treat pediatric leukemia and adult lymphoma.
The Washington Post:
Medicare Proposes Higher Payments For Innovative Cancer Treatment
Medicare officials on Tuesday proposed increasing reimbursements for a groundbreaking but costly cancer therapy used for patients whose blood cancers don’t respond to other treatments. Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said the proposed changes are necessary because “Medicare’s antiquated payment systems” have not kept up with the development of “transformative technologies.” She said she is concerned inadequate payments might be prompting hospitals to limit Medicare patients’ access to needed therapies. (McGinley, 4/23)
Stat:
Medicare Proposes A Boost In Payments For CAR-T And Other Breakthrough Drugs And Devices
Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said the agency will boost the size of extra payments it makes to help hospitals incorporate new technologies and treatments into their clinics. Medicare now pays 50 percent of the additional costs of these innovative treatments, but is proposing to increase that to 65 percent. The extra payments are available only for the first few years a new product is on the market. (Ross, 4/23)
In other Medicare news —
Modern Healthcare:
Medicare Population Budget Model Could Spur Major Pay Shift
The CMS Center for Medicare and Medicaid Innovation's planned push for a regional population-based budget in traditional fee-for-service Medicare could launch a major transformation in curbing sprawling healthcare costs for the program. That's the hope of the Trump administration's top health officials. On Monday they opened the public comment period for five primary-care pay demonstrations. (Luthi, 4/23)
Modern Healthcare:
CMS Proposes Wage Index Changes
The CMS wants to increase the wage index that sets the nation's hospital payments to address a disparity in the system. Urban hospitals would be on the losing end of this change. The rule aims to change the formula to pay rural hospitals which have some of the lowest reimbursement rates in the country. The agency late Tuesday released its annual proposed update for the hospital inpatient prospective payment system for federal fiscal year 2020 that starts in October. Overall, the CMS projected total Medicare spending on inpatient hospital services, including capital, to climb by $4.7 billion in fiscal 2020. (King, 4/23)
