BY CHRIS POPE: Providers have argued that bundled payments should not be mandatory, leaving them the option to bill under existing fee-for-service payment arrangements. But it is not possible to properly test the effectiveness of bundled payment when a skewed sample of providers selects into the program. Nor is the reform likely to save much money if providers who find the status quo more lucrative can opt for that instead.
A more reasonable criticism of Medicare’s bundle payment structures is that they may inhibit competition from cheaper sites of care, such as Ambulatory Surgery Centers, by requiring episodes to be based around hospitalizations. (read more)
BY SALLY PIPES: Medicare’s trust fund will run out of money in just over 10 years, according to a new report from the program’s trustees. Once that happens, the federal government won’t collect enough in payroll taxes to cover beneficiaries’ hospital bills.
Congress could hike taxes to cover the shortfall. Or it could ration care to save money.
Or it could modernize and restructure Medicare — by giving beneficiaries means-tested vouchers to buy private insurance. (read more)
BY JOANNE FINNEGAN: CMS issued a proposed Outpatient Prospective Payment rule last month that would pay hospitals 22.5% less than the average sales price for some drugs purchased under the 340B program, which requires drug manufacturers to provide outpatient drugs to eligible healthcare organizations and covered entities at significantly reduced prices.
Industry groups quickly opposed the proposal, saying it may harm safety-net hospitals’ ability to treat low-income patients. At present, CMS pays up to 6% more than the average sales price in the 340B program, and the rate is a longstanding Medicare policy. (read more)