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The new proposal will have grave effects on the sustainability of community oncology practices.
The Centers for Medicare & Medicaid Services (CMS) announced its proposed CY 2023 Outpatient Prospective Payment System (OPPS), which has sparked concern for the community-oncology advocate American Oncology Network (AON).
Despite the Biden-Harris Administration’s goal of increasing health equity across all geographies, promoting healthy competition throughout the healthcare industry and driving toward value-based and patient-centered care, CMS’ proposal for 2023 will undoubtedly cripple community healthcare practices.
Most concerning for community-based practices are the increase in the 340B drug pricing to the average sale price plus 6% and the rise in Medicare reimbursement rates of 2.7%. While practices affiliated with healthcare systems and hospitals reap the benefits of the OPPS proposals, independent community practices will have to reduce their payment rates to maintain neutrality and receive a decrease in Medicare payments — limiting their ability to continue providing quality care, services and medications to their patients.
“For more rural practices, like many of the community oncology practices we support, these are alarming recommendations,” said AON Chief Executive Offer Todd Schonherz. “If these actions come to fruition in 2023, they have the potential to threaten the success and growth of small-town clinics, which will then suffer financially and struggle to effectively compete with larger practices and healthcare systems that qualify under 340B.”
“Community-based clinics provide high-quality care, services and resources that are affordable and accessible,” said AON Chief Medical Officer and Genesis Cancer and Blood Institute medical oncologist Stephen “Fred” Divers, MD. “These practices are critical players in closing the cancer care gap and driving healthcare equity. If they do not receive the support needed to continue providing care in their communities, our healthcare system has done a disservice to them and failed.”
CMS is accepting comments on the proposed OPPS through September 13, 2022 and the final ruling is scheduled for November 2022.
“We encourage practices, providers and networks to comment against the proposed OPPS to safeguard community-based care and keep healthcare affordable and accessible,” said Divers.
For more information about CMS’ 2023 OPPS, visit https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center.