Mark N. Painter, CPMA, MBS, Neal D. Shore, MD, FACS, and David S. Morris, MD, FACS, discussed “2025 Medicare Part D Changes: Physician’s Perspective ” for the Grand Rounds in Urology audience in October 2024.
How to cite: Painter, Mark N. “2025 Medicare Part D Changes: Physician’s Perspective .” October 2024. Accessed Oct 2024 . https://grandroundsinurology.com/2025-medicare-part-d-changes-physicians-perspective/
2025 Medicare Part D Changes: Physician’s Perspective – Summary
Mark N. Painter, CPMA, MBS, Managing Partner, Consulting LLC, CEO, PRS Urology Service Corporation, Vice President of Coding and Reimbursement Information and CEO Relative Value Studies, Inc. is joined by Neal D. Shore, MD, FACS and David S. Morris, MD, FACS to discuss the physician’s perspective on the upcoming Medicare Part D updates. They share the benefits of these changes and the possible hardships as well.
In this third part of this series, Mark briefly highlights the Medicare Part D changes, such as the reduction of the maximum out-of-pocket expenditure and the Medicare Prescription Payment Plan (MPPP) or “smoothing option”, that the first part of this series covers in more detail. Neal D. Shore, MD, FACS and David S. Morris, MD, FACS then join Mark to share their point of view as physicians on how they are planning to maneuver these changes in the best way. David S. Morris, MD, FACS discusses how he thinks these changes will give a positive outlook to a patient’s finances, for example with the smoothing option or through grants. Also, Neal D. Shore, MD, FACS shares how offices have to prepare to help patients through the process of understanding and taking advantage of these upcoming updates.
This 15-minute discussion concludes with all speakers agreeing that the financial burden on the patient is key when it comes to medications, but they are cautiously optimistic that these upcoming changes will benefit patients, although many will still rely heavily on grants and funding to get the medications they need. Both physicians share in their hope that the upcoming Medicare Part D changes will be a step in the right direction to making healthcare more accessible to all patients and a reminder: Open Enrollment begins October 15, 2024, and runs through December 7, 2024.
ABOUT THE AUTHOR
Neal D. Shore, MD, FACS, graduated from Duke University and Duke University Medical School. He completed his general surgery/urology residency at New York Hospital-Cornell Medical Center/Memorial Sloan Kettering Cancer Center. He serves as the Medical Director for the Carolina Urologic Research Center and is the Chief Medical Officer, Strategic Growth and Pharmacy, GenesisCare, US.
Dr. Shore has conducted more than 400 clinical trials, focusing mainly on genitourinary oncology, and has authored or coauthored more than 350 peer-reviewed publications and numerous book chapters. He serves on the Society for Immunotherapy of Cancer (SITC) Guidelines Committee for Bladder Cancer, as well as the boards of the Bladder Cancer Advocacy Network, Maple Tree Alliance, and the Duke Global Health Institute. He is the Chair of both the Prostate Cancer Academy and the Bladder/Kidney Cancer Academy for the Large Urology Group Practice Association (LUGPA) Specialty Network. He also co-chairs the annual AUA International Prostate Forum. He has served/serves on the editorial boards of Reviews in Urology, Urology Times, Chemotherapy Advisor, OncLive, PLOS ONE, Urology Practice, JUOP and World Journal of Urology, and he also serves as an editor of Everyday Urology-Oncology. He is a Fellow of the American College of Surgeons.
David S. Morris, MD, FACS, graduated summa cum laude from Vanderbilt University and earned his doctorate from Vanderbilt University School of Medicine in Nashville, Tennessee. Dr. Morris completed his residency training at the University of Michigan in Ann Arbor, Michigan, with a special research interest in genetics that predict the aggressiveness of prostate and bladder cancers. He authored and co-authored multiple scientific papers throughout his training and has presented research findings at regional and national meetings. He helps coordinate the genitourinary cancers program at Urology Associates’ Advanced Therapeutics Center as well as the Urology Associates Clinical Trials Program.
Mark N. Painter is a managing partner of PRS Consulting LLC, the CEO of PRS Urology Service Corporation, the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc., and CEO of Relative Value Studies, Inc. Since co-founding PRS in 1989, Mr. Painter has served as the primary coding resource for the PRS products currently produced and marketed in conjunction with 9 National Specialty Organizations including hotlines, coding manuals, and quick reference tools, the internet-based application codingtoday.com, and seminars. He has lectured to a variety of groups concerned with healthcare reimbursement. Mr. Painter’s extensive knowledge of physician documentation, as well as coding and reimbursement issues, has allowed him to assist insurance companies, physicians and their staff members, legal counsel, actuaries, specialty societies, consultants, and the medical industry on a daily basis. Mr. Painter has been the lead for the company on multiple corporate/physician integrity agreements serving as the Independent Review Organization (IRO), and has successfully overseen the review and continued participation in Medicare of several practices from multiple specialties. Mr. Painter has been commended for his education and direction for appropriate documentation and coding by multiple Medicare medical directors with whom he has shared the podium during national and regional medical meetings. He serves as an expert in legal counsel for bio device companies, medical directors, and pharmaceuticals.
