I Love the Reform
A nonprofit hospital administrator’s thank-you note to the rule that cut his drug payment and raised his facility fee by the exact same amount.
They finally came to reform me.
I have never felt so protected.
CMS wants to fix 340B, equalize the facility fee, and set the surgery center free. Three of my favorite sins, one proposed rule.
I read all of it.
Then I poured a drink and thanked them.Because I saw this coming a year ago.
And a man who plays chess does not flinch when you finally make the move he has been waiting for.
IN TODAY’S ARTICLE:
Why the $5.7 billion “cut” to my drug payment never leaves my building.
The one line in the rule, worth $260 million, that could actually end me. And why nobody is talking about it.
How the reform kills the physician down the street before it ever reaches me.
Glossary at the bottom of today’s article.
THEY GAVE YOU A HEADLINE
Start with the gift.
CMS says it will pay for my 340B drugs at what I actually paid for them. Today they pay me six percent over what the drug costs. They want to pay me a third under it. No more spread on the pill. They even put a number on it. Five point seven billion dollars, handed back to patients and taxpayers.
Every reporter in America wrote the same sentence.
The hospitals lose the spread.
Let them write it.
I taught them that sentence.
A concession you announce is a concession you control. I gave them 340B the way you give a child the loud toy, so they stop reaching for the sharp one.
THE PARAGRAPH NO ONE KNOWS
Now the line the headlines skipped.
The law says this cut has to be budget-neutral. The five point seven billion cannot leave the outpatient system. It has to be redistributed. Back into my payments. For everything that is not a drug.
I read it twice.
Then I smiled.
They take the money off my pharmacy line. Then they hand it back to me on my facility line. Every scan. Every procedure. Every outpatient minute in the building I already own.
It is a cut that funds a raise.
I lose the spread on the tablet, and I collect it back on the MRI. The same MRI I told you about. The one that collects two thousand dollars across a street where the office collects three hundred.
They did not take my money.
They moved it to the register I like better.
THEY CAN ONLY TOUCH THE SMALL POT
And notice which money they reached for.
Medicare.
That is all CMS can set.
The rule stops at the edge of the federal program.
The spread I actually live on is the commercial one.
I buy the drug at the 340B discount.
I bill the employer’s plan at the full commercial rate.
I keep the difference.No rule this week touches a dollar of that.
They reformed the pot I show the public.
They never found the pot I keep.
Every outlet will tell you the hospitals lost $5.7 billion this week.
Almost none will show you where it lands instead.
100,000 physicians, executives, and lawmakers read where it lands.Subscribe to The Rojas Report
