Highmark to Eliminate Cancer Care Markups

Health insurer Highmark has announced it will get rid of markups on certain cancer care services.

As health systems and large hospitals acquire physician oncology practices and bill for care as hospital outpatient department services, the cost of infusion chemotherapy treatment has increased significantly, according to a news release.

HOPDs are paid significantly more than physician offices and ambulatory surgery centers for outpatient services. Medicare paid HOPDs 78 percent more than ASCs for the same procedure in 2013, according to the Medicare Payment Advisory Commission. MedPAC has recommended Congress reduce or eliminate this difference in payment rates.

Highmark customers, public officials and community members have raised objections to higher cancer care costs, according to the release. Therefore, on April 1, the insurer will restore "more rational payments" for oncology-related care such as infusion chemotherapy drugs.

"Because of this practice, many cancer patients in western Pennsylvania pay much more for their infusion chemotherapy treatments than they should — without any care improvements," William Winkenwerder Jr., MD, president and CEO of Highmark, said in the release of the markups. "We feel a responsibility to take action for our members and estimate that this billing change will save our community more than an estimated $200 million annually, with no impact to the quality of cancer care."

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