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Episode 20: Our Take July–Part 3

Aug 09, 2018


John shares our take on what happened in health care at the end of July, including how the Centers for Medicare and Medicaid Services is proposing both a rule for site-neutral payments, as well as potentially more 340B cuts.

  • The Centers for Medicare and Medicaid Services (CMS) has proposed a rule to move toward “site neutral” payments for clinic visits, under the 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. Clinic visits are “essentially checkups with a clinician,” CMS said, and are the most common service billed under OPPS.
  • CMS proposed to reduce 340B payments in 2019 to non-excepted off-campus departments of hospitals that are paid under the physician fee schedule. Earlier this year, CMS had already reduced $1.6 billion in Medicare outpatient drug payments to some 340B hospitals.

In this episode

John Marchica

John Marchica is a veteran health care strategist and CEO of Darwin Research Group. He was the founder and CEO of FaxWatch, a leading business intelligence and medical education company and two-time member of the Inc. 500 list of America's fastest growing companies.

John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade. John earned his B.A. in economics from Knox College, an MBA and M.A. in public policy from The University of Chicago, and completed his Ph.D. coursework and doctoral exams in clinical epidemiology and health economics at The Dartmouth Institute for Health Policy and Clinical Practice. He is a faculty associate in the W.P. Carey School of Business and the College of Health Solutions at Arizona State University.

About Darwin Research Group

Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.


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