Thanks to Kaiser Health News for including me in
this survey of things that CMS might do to reduce Medicare costs. It was fun to offer my comments on Skype. Regular readers will not be surprised to hear some thoughts about the proliferation of proton beam machines because of
the perverse rate structure in effect at the federal level.
How timely. Today's Wall St. Journal cites a J. NCI study saying proton beam offers no long term benefits over traditional radiation despite far higher costs. Want to dent Medicare costs for the fiscal cliff? Paul tells them where to start, tomorrow indeed.
ReplyDeleteNonlocal
Proton beam therapy looks like a classic candidate for reference pricing to me.
ReplyDeletePlease explain, Barry. Thanks.
ReplyDeletePaul –
ReplyDeleteReference pricing means that if there are two different drugs that are equally effective or two different ways to treat a disease or condition like prostate cancer but one is much more expensive than the other, insurers would pay only the cost of the less expensive, option no matter which one is selected. The patient would have to pay the entire difference between the less costly and more costly approach out-of-pocket if he or she wants the more expensive option. If Medicare operated this way, it would pay only $19K for both IMRT and proton beam therapy to treat prostate cancer. If hospitals need to charge much more for the proton beam approach to cover their costs, the patient would have to pay the entire amount above $19,000 which very few could afford to do.