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ACR, medical societies warn Congress against Part B change
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Eleven medical societies, including the American College of Rheumatology, have urged Congress to prevent CMS from applying Merit-based Incentive Payment System adjustments to Medicare Part B payments, arguing such a move would “penalize physicians for providing high-quality care,” according to a press release.
In a joint letter to members of the Senate Finance committee, as well as the House Ways and Means and Energy and Commerce committees, the ACR, the American Academy of Ophthalmology, and the American Society of Clinical Oncology among others, warned legislators that if Merit-based Incentive Payment System (MIPS) adjustments were implemented in Medicare Part B, it would jeopardize the ability of specialists to provide the physician-administered drugs their patients need.
According to the ACR, these drugs, covered under Part B, include therapies that are not generally available at pharmacies, and are not part of Medicare Part D prescription drug plans.
“Many patients with autoimmune diseases like rheumatoid arthritis require ongoing treatment with life-changing medications that are administered by their doctor in the clinic or hospital, because of medical conditions or other barriers that prevent them from self-administering a drug,” Angus B. Worthing, MD, FACP, FACR, chairman of the ACR Government Affairs Committee and clinical assistant professor of medicine at Georgetown University Medical Center, told Healio Rheumatology. “This new Medicare policy could prevent doctors from providing these drugs.”
According to Worthing, doctors who participate in Medicare’s MIPS program will be informed if they have a penalty coming in the next year, and that penalty will be taken out of reimbursements on all items and services that doctor provides — including expensive RA treatments for which the doctor earns about a 4% margin to cover costs.
“The penalties may start as high as 4% and grow to 9% over 4 years, thereby wiping out the clinic’s financial viability and incurring large losses if the doctor provides such a treatment,” he said. “This will prevent doctors from providing needed medicines, and force patients to either change medicines or obtain them at a new service site that may be inconvenient or expensive.”
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established a range of bonuses and penalties that could be applied to Medicare providers through MIPS payment adjustments.
However, in its 2018 Quality Payment Program final rule, CMS announced that it will immediately begin to impose those payment adjustments to Part B drug payments in addition to physicians’ services under the Medicare fee schedule.
According to the ACR, the current Medicare Part B drug payment structure “already makes it difficult for certain providers — particularly small and rural providers — to shoulder the financial burden of procuring and administering expensive Part B drugs.” The joint letter states that the new MIPS policy change would exacerbate this problem by fostering volatility and financial uncertainty for physicians who administer these drugs.
“While we had substantial and bipartisan Congressional support for a message to CMS to reevaluate their interpretation of the MACRA statute, CMS did not heed that request,” the letter states. “We now need Congress to act immediately to curtail this policy and ensure patients have access to all the services and treatments they need.”
The letter also urges Congressional leaders to address the weighing of the MIPS cost score category.
According to the societies, CMS has not outlined sound risk adjustment methodologies for physicians with patients at risk for high resource use. They added that cost measures necessary under MIPS are still under development.
“Work remains to ensure that the new measures are developed and integrated in a way that accurately reflects the complexities of cost measurement and does not inadvertently discourage clinicians from caring for high-risk and medically complex patients,” the letter states. “We believe that these methodologies and measures must be developed and validated before CMS moves forward with implementing this category.”
The letter concludes: “Taken together, these two issues could create a perfect storm for specialties whose patients depend on physician-administered drugs.” – by Jason Laday
To view the full letter, click here.
Disclosure: Worthing reports that he is chairman of the ACR Government Affairs Committee.