From a same-day payment cut to AI-run prior authorization in traditional Medicare, MGMA's government affairs team laid out what Washington has in store for physicians next year.
News|Slideshows|August 15, 2024
How much 10 drugs will cost under Medicare price negotiation
Author(s)Richard Payerchin
Savings in the future on 10 prescription drugs for taxpayers and Medicare patients.
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On Aug. 15, the U.S. Centers for Medicare & Medicaid Services (CMS)
The new prices will go into effect in 2026 with estimated savings of $6 billion for taxpayers, and another $1.5 billion in savings for out-of-pocket costs for beneficiaries.
So what are the drugs?
This slideshow includes the drug name, commonly treated conditions, prices and savings. The data come from the White House and CMS.
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MGMA's government affairs staff walked through the fee schedule, value-based care, prior authorization, Medicaid and the year-end fight in Congress.
EBRI data show employer plans pay hospital outpatient departments about twice what physician offices receive for the same physician-administered drugs, and the commercial market has barely begun to address the gap.
MGMA members described capping Medicare Advantage contracts and favoring commercial patients, while one Texas practice leader reluctantly called Medicare her best payer.
At an MGMA Government Affairs town hall, attendees raised extrapolated audits, employer plans beyond state reach and denials with no reason codes.
Four forces created the perfect storm to sink physician-owned medicine. There are policies that could help keep it afloat.
What do providers owe patients when a GLP-1 is out of reach? At the very least, they should stay informed.
Behavioral health has historically taken a back seat to physical health in primary care. That approach is shifting, as growing evidence underscores the importance of whole-person well-being in improving patient outcomes, strengthening care coordination and advancing value-based care.
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