SOFIE’s Post

IQ Medical Services welcomes the Centers for Medicare & Medicaid Services' (CMS) release of the proposed Medicare Hospital Outpatient Prospective Payment System (OPPS) Rule for calendar year 2025. This proposal signifies a positive step towards improving access to critical diagnostic radiopharmaceuticals for patients across the United States. We remain committed to collaborating with industry stakeholders to advocate for a #reimbursement system that allows for not only innovation in nuclear medicine, but better patient access to the most clinically-relevant advances in care. #HealthcareEquity #OPPS

Proud moment for team Noctrix Health, Inc. and to say this monumental is an understatement. WHY you should care from 3 perspectives. (Apologies, this is a lengthy one!) #𝟭 𝗧𝗵𝗲 𝗣𝗮𝘁𝗶𝗲𝗻𝘁: I'd venture to say that insurance/payer coverage is perhaps the 𝘀𝗶𝗻𝗴𝗹𝗲 𝗴𝗿𝗲𝗮𝘁𝗲𝘀𝘁 𝗯𝗮𝗿𝗿𝗶𝗲𝗿 𝘁𝗼 𝗮𝗱𝗼𝗽𝘁𝗶𝗼𝗻 (and therefore, impact) for /ANY therapeutic (drug, device or digital) that requires a prescription. This is more true today than ever before and if you're a sufferer of RLS, know that this recognition from CMS greatly accelerates the availability of life-changing technologies like these. #𝟮 𝗧𝗵𝗲 𝗣𝗿𝗼𝘃𝗶𝗱𝗲𝗿: I have had the privilege of learning from and collaborating with 100s of world-class physicians and caregivers - your commitment to patient care is truly beyond selfless. You go out of your way to ensure patients not only have access to life changing therapies but also keep an eye out for their financial interests. This decision from CMS allows you to add Nidra to your arsenal with a little more ease and do what you really do best- get patients the relief they deserve. #𝟯 𝗠𝗲𝗱 𝗗𝗲𝘃𝗶𝗰𝗲 𝗜𝗻𝗻𝗼𝘃𝗮𝘁𝗼𝗿𝘀: When Noctrix was but an idea back in 2016, it was hard to imagine what the journey to truly realizing clinical impact might look like. From our first trial, to a Breakthrough Device Designation, to FDA clearance to a dedicated reimbursement code - for all the innovators grinding it out there, this should give you immense hope to persevere. Throughout that journey, the one thing that never changed- our 𝗱𝗲𝘀𝗶𝗿𝗲 𝘁𝗼 𝗶𝗺𝗽𝗮𝗰𝘁 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝗹𝗶𝘃𝗲𝘀 forever and for the better. Onwards to changing the standard of care for RLS, and to better nights of sleep!

In January, CMS announced it would now reimburse for select patient navigation services. Experts, including our own Clara N Lambert, explain what the ruling means and next steps for the navigation field. ⬇️ 💡 Research has shown that patient navigation improves access and outcomes for people with cancer and other serious conditions. But navigation (including financial navigation) is still an emerging field. Find out what Clara and other experts have to say about effective navigation including: 📖 Training 👩🏻🏫 Navigator professional development 👩🏻💻 Program implementation and evaluation … and more Centers for Medicare & Medicaid Services Association of Cancer Care Centers #Medicare #Medicaid #patientnavigation #financialnavigation

We’ve heard from patients and providers about access issues for medicine scans.   These critical diagnostic scans use radiopharmaceuticals to help physicians identify certain diseases more effectively, including Alzheimer’s, Parkinson’s, advanced cardiovascular disease, and prostate cancer.   The Centers for Medicare and Medicaid Services (CMS) needs to address the payment packaging of radiopharmaceuticals. #radiopharmecuticals #Medicare #Medicaid #CMS #centersformedicareandmedicaid #patients #patientcare #healthcare #healthcareproviders #CMSservices #medicinescans #ussenate #uscongress https://lnkd.in/eGRMHigx

Regs & Eggs from McDermott+Consulting is out! This week, my colleagues Leigh Feldman and Julia Grabo, and I, discuss new Centers for Medicare & Medicaid Services (CMS) alternative payment models geared towards hospitals-- some of which are "mandatory models" (those that require selected hospitals to participate). This "buffet" of models could lead to an overwhelming number of entrees. There is a potential for hospitals (and patients) to be in multiple models at the same time, which leads to many questions around administrative burden and appropriate attribution of costs and savings. It could also affect hospitals' willingness to participate in voluntary models going forward. Read more here! https://lnkd.in/dGPB6NGf

NEW: Our Executive Chairman, Al B Sure!, and Senior Advisor, Reverend Al Sharpton, are calling on the Centers for Medicare & Medicaid Services (CMS) to restore Medicare coverage for critical diagnostic blood tests without any ties to biopsies, following CMS’ recent Billing Article and public statement highlighting a revision to its March 2023 coverage policy. “The CMS revision and statement last week does not clarify whether access to these tests for organ transplant recipients on Medicare is tied to a biopsy,” says Al B. Sure! and Rev. Al Sharpton. “Biopsies are painful, risky, and are often prescribed too late – by that point, organ rejection may have already begun. The purpose of these blood tests is to catch a rejection before it happens, which is nearly impossible if they are linked to a biopsy.” Read Al B! and Rev. Sharpton’s full statement in response to CMS’ Billing Article and public statement: https://bit.ly/3Iv8xqc

A view point in JAMA Oncology talks about how "Federal Transportation Regulations Limit Access to Clinical Trials and Oncology Care" JAMA, Journal of the American Medical Association Oncology 👉 Traveling for cancer care can be a barrier for patients, as treatment occurs over months, requires numerous appointments, and can be expensive, multimodal, and intensive. In surveys, 12% to 30% of patients with cancer report transportation barriers, which can lead to delayed care, missed appointments, limited access to specialized oncology care, and lower rates of evidence-based care, each of which can increase morbidity and mortality. 👉 Patients with Medicaid are at particular risk of delayed care due to structural and social barriers to care. Yet in 2019, federal regulations newly limited nonemergency medical transportation (NEMT), a key transportation program for Medicaid patients that gets patients to and from care, up to 25 miles for urban patients and 75 miles for rural patients. 👉 There were no prior mileage limits for the 6.2 million people in the US who use NEMT. 👉 While the regulation governs Medicaid, patients with private insurance and Medicare are also affected by the new mileage limits, as other insurers and health systems look to Medicaid policy to structure any transportation benefits https://lnkd.in/ejKD_q3R

Resharing a must-read: "Discussing Lymphedema Treatment Act, Coverage With Patients" via Oncology Nursing News. This insightful article underscores the vital role healthcare providers play in educating patients about the expanded Medicare coverage under the Lymphedema Treatment Act. It offers actionable tips for conversations about coverage changes, aiming to empower patients with knowledge of their entitlements and the positive impact on their care. 👉 Learn more about navigating these discussions and the significant strides in patient rights and treatment access - https://lnkd.in/eNNyRMTG #LymphedemaCare #OncologyNursing #PatientRights #HealthcareCoverage

My new commentary in Medical Economics about how the Centers for Medicare & Medicaid Services restrictive coverage policies are denying patients with early Alzheimer’s disease access to novel treatments. And private payers are following suit. 💡 Dear payers: People living with early Alzheimer's disease are 'worth it': https://lnkd.in/eR7RMMT7 #CMS #Medicare #Alzheimers #WorthIt

On August 1, 2024, CMS released the FY 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule. Key updates include: 1. Payment Increases: 2.9% increase for general acute care hospitals and a 3.0% increase for LTCHs. 2. New Technology Payments: Increase for new medical technologies and gene therapies. 3. Labor Market Adjustments: Updated wage index based on 2020 Census data. 4. Quality Measures: Addition and modification of quality measures, focusing on patient safety and health equity. 5. Essential Medicines: New payments to small hospitals to maintain essential drug stocks. For more details, click the link below.