The Medicare Payment Advisory Commission’s (MedPAC) recent report to Congress recommended that Congress and the Centers for Medicare & Medicaid Services (CMS) should use demonstration projects not to increase payments and make payment policy but to test innovations in health care. The report evaluated the effects of changes in how Medicare pays for drugs administered by oncologists. Panelists noted that the 2005 quality of life demonstration project added about $200 million in payment to providers. Many physicians reported to MedPAC that they did not believe that the 2005 demonstration project would improve quality of care or provide useful information, but noted that demonstration project payments enabled them to continue to care for Medicare patients.
Practice Manager Insider editorial board members Larry A. Oday and Elaine L. Towle, CMPE, concurred with this advice. “Payment for demonstration projects is good incentive for participation,” said Towle, program director at Oncology Metrics. But “the current Medicare payment system needs fundamental change, not year-to-year Band-Aids in the form of demonstration projects.”
Oday, a Washington-based health care attorney, had this comment regarding the demonstration projects: “CMS is abusing its authority. If it can [use its authority] to give money, it won’t hesitate to use it to take money away. Demos are, by definition, an experiment. They are not to be used for political pork barrel.”
MedPAC also recommended an exception to the Competitive Acquisition Program (CAP) oncology drug delivery rules for rural practices. Under the existing rule, drugs must be delivered to the site where the medications will be administered. Rural practices often administer drugs in satellite offices at which they cannot receive and mix medication. MedPAC recommended that CMS allow such practices to accept drug deliveries at their main offices so that they can participate in the CAP.
Towle predicted that this will have limited effect on CAP participation. “While I believe that very few medical oncologists will choose to participate in the CAP program, the recommendation regarding rural practice sites may influence this decision for some,” said Towle.
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