Data show that the majority of Americans experience stress tied to medical costs for treating illnesses or purchasing medications. Premiums for most health insurance plans continue to increase as more patients find themselves paying more out-of-pocket in the form of higher co-pays and deductibles.
Cancer patients face particular hardship. A recent survey found that 70 percent of cancer patients face financial difficulty related to their treatment expenses and only one-quarter of patients said they had a full understanding of the out-of-pocket costs they would incur during treatment. In another recent survey, three-quarters of responders said a cancer diagnosis would have a catastrophic impact on their finances.
However, proposed payment reforms offer hope for reduced costs for both patients and taxpayers. Over the summer, the Centers for Medicare & Medicaid Services (CMS) unveiled a new set of reforms that would enormously benefit patients, lower out-of-pocket costs, and reverse a growing trend of practice consolidation that limits patient access to care – all while saving the Medicare program millions of dollars each year.
The reforms come as a part of the agency’s 2019 Outpatient Prospective Payment (OPPS) system proposed rule which included a proposal to close a loophole that allows hospitals to overbill Medicare by exploiting payment disparities between different reimbursement schedules. Most independent physician offices are typically reimbursed through the Medicare Physician Fee Schedule (PFS) which pays less than OPPS for the exact same services. For example, Medicare’s OPPS schedule pays $123 for basic services such as Evaluation and Management (E/M) office visits, while the PFS only pays $72 – a difference of $51. Reimbursements for other common services such as chemotherapy, colonoscopies and even basic blood tests are also substantially higher when performed in the hospital outpatient department setting.