2013
Read the following news story and then think about its implications. I don’t know if the price of this test is fair or exorbitant, I don’t know if the Medicare pricing allows a fair return to the provider.
But I do know one thing for sure, the government, in this case Medicare, has the power to pay whatever it wants to pay. You may feel that is a good idea; screw the health care providers that are ripping us off. 👅
However, this is a large and growing bandwagon. The more the solution to health care costs is simply cutting what will be paid, the more dire the possible consequences. This is especially true when only the government has this ability. For one thing it means more cost-shifting to private plans and individuals. Carried to its extreme it may also stifle innovation and create shortages or hamper access while raising prices for some consumers. This is starting to happen in the Medicare (Part C) Advantage plans.
While the government cuts fees at will, your insurer must negotiate fees and to do so must have leverage over providers. As this leverage shifts to providers through consolidation, more cost-shifting occurs. Insurers react by limiting their networks and delivering higher volume to those smaller networks. The result is less choice for consumers. Does all this sound familiar?
In any case, we should not lose sight of the fact that the health care system is all connected. No one payer be it government, private insurers or individuals can make changes without affected the others. Health care providers must deal with all these entities in an uncoordinated morass of regulations, rules and contracts.
What makes us think such a system can ever achieve maximum efficiency or not create adverse consequences as it plugs along?😳
NEW YORK (MarketWatch) — The price of a popular genetic test that predicts women’s risk of breast cancer is likely to drop in the New Year after the agency that administers Medicare benefits said it would slash its reimbursement rate for the test by half.
The rate cut goes into effect on Jan. 1, 2014, with consequences for genetic-testing companies, particularly Myriad Genetics Inc. MYGN -16.11% , the dominant supplier of screenings for mutations in the genes known as BRCA1 and BRCA2. Medicare will pay a maximum of $1,440 for the BRCA test, a 48.5% decline from the rate of $2,795 it paid in 2013, according to a notice published Friday afternoon on the website of the Centers for Medicare and Medicaid Services.
Myriad charges a list price of $3,340 for its most-comprehensive BRCA test, according to regulatory filings, though the amount actually paid varies depending on the discounts negotiated by individual insurers.
via Medicare cut for breast-cancer risk test starts Jan. 1 – MarketWatch.
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