This article provides a sweeping historical and modern day perspective on the care delivery ecosystem beyond the four walls of a hospital. While site of care (hospital, community, home, remote, etc.), and its appropriateness / value remains a hot topic of debate, there is no questioning that ultimately the best interests of the patient should govern where care is received / delivered. For oncology/hematology patients, safe, convenient and high quality / low cost care is best received in community settings, like here at Florida Cancer Specialists & Research Institute.
Compliance of National Cancer Institute–Designated Cancer Centers With January 2021 Price Transparency Requirements
Nathan Walcker's Thoughts
While price transparency across sites of care on its face is a step in the right direction, datapoints when viewed discretely are less informative when it comes to the actual costs associated with cancer care. Additional work, analysis and research is much needed across the stakeholder continuum to fully understand the costs associated with the treatment of cancer, and to further achieve the transparency goals set forth by CMS in 2019 with this initiative.
In an effort to increase competition and drive down prices, the Centers for Medicare & Medicaid Services (CMS) initiated 2 policies in the last 3 years to increase hospital price transparency.1 Starting January 2019, hospitals were required to publish their chargemasters—a list of the nondiscounted prices for services provided. This effort has been criticized because charges rarely reflect the actual prices paid for a service and do little to spur competition.2,3 In response to this criticism, CMS expanded this mandate in January 2021 to require hospitals to publish a list of their negotiated rates with health insurers. In theory, this should more effectively increase competition between payors and hospitals and drive down rates.
Author Affiliations1Department of Surgery, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, California, 2David Geffen School of Medicine at UCLA, Los Angeles, California,3Department of Molecular, Cell, and Developmental Biology at UCLA, Los Angeles, California
STAT News published the below Op Ed from COA that does that highlights the dysfunction of the 340B system and how Hospital Systems and PBMs are profiting Billions of dollars a year off of a program that was intended to help underserved patients. Is a great “high level” review to help understand the overall impact on the US medical system and the importance of health care reform in this area.
Here we see a review of literature assessing the impact of patient assistance programs on outcomes broadly in cancer care. While indirect links may be drawn between the prevalence of financial toxicities and outcomes, adherence, etc., additional research studies are needed to more clearly demonstrate the tangible impact of these programs to support future investments from stakeholders.
Analysis of 61 NCI-designated cancers demonstrate parenteral cancer drug price markups across all centers ranging between 188.4% to 633.6%. Only 27 centers publicly disclose payer-specific prices for cancer therapies as required by federal regulation. Authors recommend public policies to discourage excessive hospital price markups on patenteral chemotherapeutics to reduce financial burden on cancer treatment for patients.
Thought-provoking oped highlighting the underbelly of buzzwords in healthcare today. The shift from volume to value that we’ve seen unfold over the past 3-5 years has moved front and center in many conversations, yet remains elusive insofar as its definition and implementation. This article rightly calls out that value is ultimately in the eye of the beholder, and yet there’s no disputing that doing what’s right for the patient trumps all.