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Melissa Morley

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An Avalere analysis found that Oncology Care Model (OCM) lung cancer episode expenditures increased over 20% from performance periods 2 to 6 while the benchmark price increased about 10% during this period. During this same period, The Center for Medicare & Medicaid Innovation (CMMI) included 20 lung-cancer-specific changes to the OCM Novel Therapy Adjustment (NTA) list. This dynamic supports the inclusion of tumor-specific adjustments in the future Oncology Care First (OCF) model to further account for advancements in cancer management.

The roll-out of the Patient-Driven Payment Model (PDPM) in October 2019 followed quickly by the COVID-19 pandemic presents challenges to understanding the extent to which increases in payment to skilled nursing facilities (SNFs) are due to the changes in the payment system versus changes in the patient populations served during the COVID-19 pandemic. Given the confounding effects of the pandemic and the new payment system, it is important to collect more data before evaluating the transition to the PDPM.

The US continues to face challenges with managing COVID-19 (SARS-CoV-2) while reopening communities. Accurate COVID-19 diagnostic testing is an effective tool in minimizing the risk of transmission.

An Avalere analysis found that among high-risk breast cancer episodes, those in later stages of the disease had higher episode expenditures relative to their benchmarks compared to those in earlier stages.

An Avalere analysis found that lengthening episode duration from 6 months to a year would not have a large impact on the relationship between episode expenditures and benchmark costs, meaning that performance on longer episodes would not improve relative to shorter episodes.

Avalere analysis finds hospitals would receive higher additional payments from Medicare through the New COVID-19 Treatment Add-on Payment (NCTAP) compared to the New Technology Add-on Payment (NTAP).

New analysis from Avalere finds that Medicare beneficiaries are more likely to receive Part D autoimmune drugs and less likely to receive Part B autoimmune drugs from providers who are part of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) compared to non-ACO providers.

New Avalere Health analysis of Medicare fee-for-service (FFS) claims data reveals large decreases in skilled nursing facility (SNF) and home health care use following the widespread decline in inpatient hospitalizations amid the response to the COVID-19 pandemic. Avalere’s analysis further suggests that as inpatient procedures resume in some areas, the volume of inpatient hospital discharges to home health is starting to rebound, whereas the volume of discharges to SNF remains below 2019 levels.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion for the Public Health and Social Services Emergency Fund—known as the Provider Relief Fund (PRF)—and subsequent legislation appropriated an additional $75 billion through the Paycheck Protection Program and Health Care Enhancement Act.

New analysis from Avalere finds the proposed case-mix adjustment for the radiation oncology model underestimates payments for prostate cancer .