A biologist works on immunotherapy for HPV+ cancers at the National Cancer Institute. Photo: Saul Loeb/AFP/Getty Images

The Centers for Medicare & Medicaid Services issued a proposed rule yesterday addressing Medicare hospital payments in 2020, including how hospitals will be reimbursed for CAR-T therapies.

The big picture: These are medical procedures that use a patient's own cells to fight cancer — a treatment that also comes with a high price tag.

Details: The proposed rule narrows the gap between what Medicare pays for CAR-T and what the drug companies that make it charge, but there's still a substantial gap.

By the numbers: Hospitals can lose upwards of $100,000 when they administer CAR-T therapies to Medicare beneficiaries today, because of the way payment is structured.

  • The 2 CAR-T therapies on the market have a price tag of $373,000 per procedure.
  • Right now, hospitals receive varying payment rates, which can include an add-on of up to 50% of the manufactures' price, or $186,500. Yesterday's proposal increases that add-on to 65%, or $242,450.

Between the lines: Hospitals would obviously rather be made whole for the cost of the procedure. There'd been talk of increasing the base payment by creating a new billing code for CAR-T, but CMS decided not to do that, at least not yet.

  • Outpatient reimbursement for the procedure is much more generous, as it's structured completely differently, but comes with added risk.

CMS is also considering raising Medicare rates to hospitals by 3.7% on average next year, by far the largest proposed pay hike in several years. Penalties for too many readmissions or poor quality will be opportunities for wiggle room in the Medicare price hike.

Go deeper: Stat News dug into hospitals' payment dilemma in March.

— Correction: An earlier version of this story said hospitals all get paid the same amount for CAR-T therapy. That's incorrect. Their payments vary.

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Trump's Tucker mind-meld

Photo illustration: Sarah Grillo/Axios. Photo: Roy Rochlin/Getty Images and BRENDAN SMIALOWSKI/AFP via Getty Images

If you want to understand the rhetorical roots of Trump's Independence Day speech at Mount Rushmore, go back and watch Tucker Carlson's monologues for the past six weeks.

Between the lines: Trump — or rather his speechwriter Stephen Miller — framed the president's opposition to the Black Lives Matter protest movement using the same imagery Carlson has been laying out night after night on Fox.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Global: Total confirmed cases as of 6 p.m. ET: 11,366,145 — Total deaths: 532,644 — Total recoveries — 6,154,138Map.
  2. U.S.: Total confirmed cases as of 6 p.m. ET: 2,874,396 — Total deaths: 129,870 — Total recoveries: 906,763 — Total tested: 35,512,916Map.
  3. States: Photos of America's pandemic July 4 ICU beds in Arizona hot spot near capacity — Houston mayor warns about hospitals
  4. Public health: U.S. coronavirus infections hit record highs for 3 straight days.
  5. Politics: Former Trump official Tom Bossert says face masks “are not enough”
  6. World: Mexican leaders call for tighter border control as infections rise in U.S.
  7. Sports: Sports return stalked by coronavirus
  8. 1 📽 thing: Drive-in movie theaters are making a comeback.

Bolton's hidden aftershocks

Photo illustration: Sarah Grillo/Axios. Photo: Justin Sullivan/Getty Images

The news media has largely moved on, but foreign government officials remain fixated on John Bolton's memoir, "The Room Where It Happened."

Why it matters: Bolton's detailed inside-the-Oval revelations have raised the blood pressure of allies who were already stressed about President Trump's unreliability.