Reform of the Buy-and-Bill System for Outpatient Chemotherapy Care Is Inevitable: Perspectives from an Economist, a Realpolitik, and an Oncologist.
Reform of the Buy-and-Bill System for Outpatient Chemotherapy Care Is Inevitable: Perspectives from an Economist, a Realpolitik, and an Oncologist.
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不可避免的是对门诊化学疗法护理的购买和审理系统的改革：经济学家，现实情况和肿瘤学家的观点。
DOI：
10.14694/edbook_am.2015.35.e75
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Ward JC
中科院分区：
文献类型：
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作者：
Polite B;Conti RM;Ward JC
输注或注射溶瘤药物治疗癌症患者是门诊肿瘤学实践的核心组成部分。目前，这种做法是先购买药品，然后向保险公司开具账单，俗称为“购买并开具账单”。这些药物的报销是肿瘤学实践的最大毛收入来源，随着癌症药物的价格随着时间的推移而增长，这些购买对实践的财务健康产生了重大影响，并构成了危及许多实践的运营和提供患者护理的能力的风险。由于联邦支出压力，联邦医疗保险B部分的药品支出正受到政治审查，购买和账单之间的利润率根据联邦医疗保险现代化法案降至6%，通过自动减支进一步降至4.3%，是预算讨论和提案方便且受欢迎的目标，每降低一个百分点，就能在10年预算窗口内节省数十亿美元。已经提出了购买和账单制度的替代方案，包括发票定价、成本最低的替代报销、将药品捆绑到护理事件付款中、将B部分药物转移到联邦医疗保险D部分福利，以及修订失败的竞争性收购计划。本文将政策制定者、卫生保健经济学家和提供者的观点聚集在一起，讨论肿瘤学支付改革中的这一重大挑战。
Treating patients with cancer with infused or injected oncolytics is a core component of outpatient oncology practice. Currently, practices purchase drugs and then bill insurers, colloquially called “buy and bill.” Reimbursement for these drugs is the largest source of gross revenue for oncology practices, and as the prices of cancer drugs have grown over time, these purchases have had significant impact on the financial health of practices and pose a risk that jeopardizes the ability of many practices to operate and provide patient care. Medicare Part B spending on drugs is under political scrutiny because of federal spending pressures, and the margin between buy and bill, lowered to 6% by the Medicare Modernization Act and further decreased to 4.3% by sequestration, is a convenient and popular target of budgetary discussions and proposals, scored to save billions of dollars over 10-year budget windows for each percentage-point reduction. Alternatives to the buy-and-bill system have been proposed to include invoice pricing, least costly alternative reimbursement, bundling of drugs into episode-of-care payments, shifting Part B drugs to the Medicare Part D benefit, and revision of the failed Competitive Acquisition Program. This article brings the perspectives of policy makers, health care economists, and providers together to discuss this major challenge in oncology payment reform.