The top 5 pieces of content published on AJMC.com relating to reimbursement issues included 2 on the significance of a California law giving Medicare beneficiaries access to expert oncology care; other articles looked at the work involved in value-based care models and CMS news.
The top 5 pieces of content published on AJMC.com relating to reimbursement issues included 2 on the significance of a California law giving Medicare beneficiaries access to expert oncology care. Both featured Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, and editor in chief of Evidence-Based Oncology™ (EBO). Other articles looked at the work involved in value-based care models and CMS news.
5. Cancer Payment Models Improve Care, but Making Them Work Takes Effort
An article published in October covered a session at the Community Oncology Alliance Payer Exchange Summit, where a panel discussed how making value-based payment models work in cancer care requires close attention to the financial and quality measures and a commitment to culture change. The work is painstaking and requires a laser-focused intensity as well as relationships with other organizations, panelists said.
4. Medicare Fee Schedule Expands Access to Some Services but Cuts Physician Reimbursement 4.5%
The CMS release of its 2023 Physician Fee Schedule (PFS) rule drew ire for its update to the payment rates for calendar year 2023; CMS sought to make the PFS conversion factor $33.06, which represents a decrease of $1.55, or 4.48%, from the 2022 PFS conversion factor. However, the $1.7 trillion spending package that passed Congress in December included a plan to reduce the cut by 2%. Other parts of the rule finalized policies relating to telehealth and expanding access to behavioral health care, cancer screening coverage, and dental care. CMS also released the final rule of the Hospital Outpatient Prospective Payment System, which included payment for drugs acquired through the 340B program.
3. Dr Joseph Alvarnas Explains Cancer Care Equity Act for Medi-Cal Beneficiaries
In this video interview, Alvarnas explained how Medi-Cal beneficiaries who develop cancer will be given access to one of the state of California’s National Cancer Institute (NCI)–designated comprehensive cancer centers (CCCs) or other experts centers close to home through the Cancer Care Equity Act. Medicaid patients will have access to clinical trials and to certain qualified academic center that might not be an NCI-designated CCC.
2. Alzheimer Disease Drug Lecanemab Successfully Reduces Cognitive, Functional Decline
In September, Eisai and Biogen announced topline results from a large global page 3 confirmatory trial of lecanemab that met both the primary end point and all secondary end points. The CLARITY AD clinical trial of lecanemab showed the drug reduced cognitive and functional decline by 27% at 18 months compared with placebo. A decision on lecanemab is expected in early January 2023.
1. California Takes a Step Toward Bringing Equity in Cancer Care
On January 1, 2023, the California Cancer Care Equity Act takes effect, making advanced cancer care possible for patients on Medicaid. The October 2022 issue of EBO included an opinion piece by Alvarnas in which he expands further on his thoughts about equitable care for cancer patients in California and how the law came to pass.