Lessons Learned from COVID-19 in the Care of NMIBC Patients: Insights from the CISTO Investigators

Ongoing analyses of disruptions to care during the COVID-19 Public Health Emergency (PHE) continue to help identify important insights on how the healthcare system adapted to the pandemic, as well as how cancer patients may have been affected by the PHE. The PHE led to significant disruptions in clinical cancer care, including the closure of operating rooms for elective surgeries and the repurposing of clinical visits to telemedicine, to accommodate COVID-19 patients and conserve resources like personal protective equipment. In their recent publication, Gore et al. present their data from a monthly survey initiated in May 2020 among urologists in a large pragmatic trial for high-risk bladder cancer to assess the impact of these disruptions on the surgical and clinical management of bladder cancer.

New Cancer Bundle from CMS: the Enhancing Oncology Model

The Centers for Medicare and Medicaid Services have maintained a focus on transitioning the American healthcare system from a fee-for-service payment model to a value-based payment model. Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reformed the Medicare payment system and created two new pathways to move towards value.

CMS Releases Final Rule to Broaden Access to Health Data and Improve Prior Authorization

In January 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This regulation mandates that Medicare Advantage (MA) organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-Facilitated Exchanges (FFEs), collectively referred to as "impacted payers," enhance the digital exchange of healthcare information and streamline the prior authorization process for healthcare services and products. These measures aim to simplify prior authorization, alleviate burdens on patients, healthcare providers, and payers, and are projected to yield estimated savings of about $15 billion over a decade.

National Cancer Drug Shortages: Policy Response and Potential Solutions

Although generic prescription drug shortages have been an ongoing problem over the past decade, the recent few months have brought about a severe chemotherapy shortage affecting many Americans with cancer. We explore the history and causes of this drug shortage in our last post.

The Path Forward for Telehealth in Medicare

The COVID-19 pandemic brought about a rapid expansion of telehealth services to ensure that patients were able to obtain necessary medical care without exposure to illness. Prior to this point, Medicare was very hesitant to cover telemedicine given lack of evidence regarding quality and cost, as well as effects on outcomes. As the Public Health Emergency (PHE) ended in May 2023, Congress turned to the Medicare Payment Advisory Commission (MedPAC) for an evaluation of the current state of telehealth services, and for recommendations on how to provide payment for telehealth services in the future.

National Cancer Drug Shortages: History and Current Status

Over the past decade, the United States has been facing ongoing issues regarding the supply and demand of generic prescription drugs. In general, generic drugs make up approximately 90% of prescriptions filled by American consumers. Given that these drugs are non-branded and have expired patients, they are manufactured at a lower cost.

Medicare Advantage: the Who, What, Where, Why… and What’s Next?

Over the past several years, Medicare Advantage (MA) insurance has been heavily criticized by health economists for the large degree of overpayments from Medicare, as well as by patients and physicians for restrictive networks, inconsistent coverage, and often high out-of-pocket costs for patients. Although one may think that MA plans fall under the Medicare/Medicaid umbrella based on the name of these plans, the MA program actually consists of private health plans.

House Energy and Commerce – Oversight and Investigations Subcommittee Hearing: “MACRA Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors”

On June 22, 2023, the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee hosted a hearing entitled, “MARCA Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors.”