Congress Urged to Reverse CMS Policy Linking Clinician Payments to Part B Drug Costs

Many of the nation’s leading healthcare organizations are calling on Congress to reverse the new Centers for Medicare & Medicaid Services (CMS) policy that has the potential to cause financial uncertainty for many specialists and jeopardize patient access to Part B drug therapies.¹

Despite warnings from healthcare advocates and Congressional leaders, CMS included a policy change in the CY 2018 Quality Payment Program Final Rule to adjust healthcare providers’ reimbursements for Part B drug costs based on their performance in the Merit-Based Incentive Payment System (MIPS).

In response, more than 100 healthcare organizations issued letters to the leaders of the Senate Finance; House Ways and Means; House Energy & Natural Resources; and Commerce, Science & Transportation committees to emphasize that the decision could put specialists who administer Part B drugs at financial risk and create access issues for patients who rely on Part B therapies.

“This application of the adjustment is not in line with the goals of MACRA [the Medicare Access and CHIP Reauthorization Act], is a significant departure from current policy and would disproportionally affect certain specialties,” the letters state. “We believe this policy could make it more difficult for physicians, particularly those in rural settings, to administer Part B medications in their communities, creating a dire patient access issue.”

Under the new policy change, clinicians in certain specialties — including rheumatology, oncology, and ophthalmology — who prescribe Part B drugs could see payment cuts as high as 29%, according to analysis conducted by Avalere Health.² In addition, the organizations warn that unless Congress acts quickly, thousands of Medicare patients with autoimmune diseases, cancer, or other chronic conditions will be at risk of losing access to vital therapies.

“If left as is, this policy will negatively impact patient[s]’ access to critical treatments by putting specialties that provide high-cost drugs at risk. It will significantly amplify the range of bonuses and penalties intended by MACRA, but only for certain specialties,” the letters add.

References

1. Healthcare groups urge Congress to immediately reverse CMS policy linking physician payment adjustments to Part B drug costs [press release]. Atlanta, Georgia: American College of Rheumatology. https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/871/Healthcare-Groups-Urge-Congress-to-Immediately-Reverse-CMS-Policy-Linking-Physician-Payment-Adjustments-to-Part-B-Drug-Costs. Published January 18, 2018. Accessed January 18, 2018.
2. Feore J, Kane R. CMS proposal for new Medicare payment system could lead to large payment variability for specialists. Avalere website. http://avalere.com/expertise/life-sciences/insights/cms-proposal-for-new-medicare-payment-system-could-lead-to-large-payment-va. Published October 5, 2017. Accessed January 19, 2018.