Courtney Tito’s Post

Over the past 20 years, Medicare physician pay has plummeted by 26% when adjusted for inflation, while hospital reimbursement has surged by 70%, prompting over 100,000 doctors to abandon independent practice for hospital or corporate employment since 2019. According to Dr. David Eagle, of New York Cancer & Blood Specialists, this is a threat to patient access and care quality. In an interview with The American Journal of Managed Care® (AJMC®), he discusses how the expenses associated with practicing medicine have risen by 50% since 2001, rendering it increasingly difficult for independent physicians to sustain their operations. Read more by visiting: https://shorturl.at/hkPX4

Technology can help facilitate these conversations by: 🔹 Proactively flagging financially at-risk patients 🔹 Providing an out-of-pocket cost estimate for their entire medical journey 🔹 Matching them with available financial assistance #affordability #financialtoxicity #healthcarecosts #cancercosts

The latest The Wall Street Journal Opinion article outlines how Medicare cutbacks may save money, but at the risk of hurting transplant patients. The editorial board urges the Biden Administration to reinstate Medicare coverage for non-invasive transplant tests that help monitor the health of transplanted organs. Read the full article: https://lnkd.in/gQcpXXgi. #patientadvocacy #medicare

The Centers for Medicare & Medicaid Services proposed a new mandatory model: Transforming Episode Accountability Model (TEAM). The model is designed to elevate care coordination and transitions for traditional Medicare beneficiaries undergoing select surgical procedures, including lower extremity joint replacements, surgical hip femur fracture treatments, spinal fusions, coronary artery bypass grafts, and major bowel procedures. ➡ As a mandatory model, TEAM will go through normal notice and comment rulemaking. As such, the model was included in the FY 2025 Inpatient Prospective Payment System Proposed Rule. https://lnkd.in/gGNNQSf9 

Over 24,000 Australians have emailed their local MP and asked them to Keep Pathology Bulk Billed. It has been encouraging to hear that some of you have received a response back from your MP - but these responses have not committed to increased funding for pathology in this year’s Budget. If you have a spare minute, pick up the phone to your local MP’s office and voice your concerns.  We’ve added your MP’s phone number to our website to make it easy. Use your postcode to find your MP’s phone number. Point out that: - the government needs to end the 24-year freeze on the Medicare rebates for pathology; - without fair funding, pathology services - like blood tests, will become less affordable and accessible for people like me; - we don’t want pathology to become like bulk billing for GPs, which is becoming harder to access and making healthcare more expensive. https://lnkd.in/gMf_ccjE

This article is interesting. Good database dive review. 2009-2019 physician reimbursement for cervical arthroplasty dropped 7%. Total hospital charges increased by 73% but hospitals had a net loss in caring for medicare patients due mainly to medical/surgical supplies and OR room charges. This is similar to what group found with commercial insurers which presumably covered those under 65. What a broken system.

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Pharmacy teams play a critical role in patient care and can act as champions in the fight against heart disease. With the rising financial burden of this condition, leveraging financial navigation technology is a game-changer. By guiding patients through insurance options, medication costs, and available assistance programs, pharmacists can make a significant impact on both healthcare outcomes and financial well-being. "Technology solutions can streamline the process by proactively flagging at-risk patients, creating a comprehensive list of funding opportunities, and automating enrollment." #HeartDisease #CareAccess #Technology

#FeatureArticleFriday - "CMS is proposing a new mandatory Medicare payment model to test whether performance-based incentives for hospitals might improve the hodgepodge system connecting patients who need kidney transplants with viable organs. The model would measure hospital performance based on the number of kidney transplants, organ acceptance rates and quality of transplant care. Based on those metrics, hospitals would either receive bonus payments from the CMS — up to $8,000 per transplant — or be penalized for poor performance, up to $2,000 per transplant." Read more about this here: https://lnkd.in/ghSXg7uH #Medicare #ValueBasedPayment #HealthCare

In their new Forefront article, Andrew M. Ryan, Jason D. Buxbaum, Sukruth A. Shashikumar, and Zoey Chopra from Brown University, Harvard Medical School, Brigham and Women's Hospital and the University of Michigan discuss how, as part of its strategic refresh, CMS recently signaled an interest in reforming episode-based payment in traditional Medicare. Based on their research on the topic, the authors propose a number of principles to guide these efforts. "To incentivize hospitals to manage patient care efficiently, CMS has experimented with several episode-based payment programs, including Bundled Payments for Care Improvement Advanced (BPCI-A) and the Comprehensive Care for Joint Replacement (CJR) models. Episode-based payment programs typically give participant-specific spending targets for a given bundle (for example, lower extremity joint replacement, sepsis, heart failure, and so forth). The spending target encompasses all spending occurring in a designated period following discharge, typically 90 days. Targets typically account for patient risk and are often adjusted by quality metrics. Participants whose spending is below their target receive financial bonuses, while those with spending above target may be penalized. Participation has been voluntary in most episode-based payment programs but can be mandatory, as in the CJR model." Read the full article here: https://lnkd.in/eZQmty3C