Medicare To Adopt Reference Based Pricing?

“A proposal from the Hamilton Project would give the Centers for Medicare and Medicaid Services (CMS) more resources to scrutinize medical technologies and allow the agency to experiment with “reference pricing”.

“Medicare would pay a single price for all treatments, for a given condition, that have similar therapeutic effects, up to a cost-effectiveness threshold. Patients who want to receive less cost-effective treatments could still get them, but they’d have to pay any difference out of pocket. That strikes the right balance.”  SOURCE: Why American Doctors Keep Doing Expensive Procedures That Don’t Work

Reference Based Pricing is a growing market phenomenon. Mostly limited to small and midsize firms across the country, larger groups are beginning to adopt the strategy. The State of Montana and the Oklahoma Medical Association are cases in point.

It’s hard to argue against common sense strategies in lowering healthcare costs………………….



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