WASHINGTON, D.C. – Eleven leading medical societies – including the American College of Rheumatology, American Academy of Ophthalmology, American Society of Clinical Oncology and American Urological Association – are urging congressional leaders to preserve patients' access to critical Part B drug treatments by preventing the Centers for Medicare & Medicaid Services (CMS) from penalizing physicians for providing high-quality care.
In letters recently sent to the chairs and ranking members of the Senate Finance, House Ways & Means and House Energy & Commerce committees, the groups warn of serious impacts to patient access to care should Congress fail to prevent CMS from applying Merit-based Incentive Payment System (MIPS) adjustments to Part B drug payments. This ill-advised policy change could jeopardize patients in the communities most in need of access to these important treatments, the groups warn.
"This policy will negatively impact patients' access to critical life- and sight-saving treatments," the letter states, as it would put at risk the ability of specialists to provide the physician-administered drugs on which their patients depend. Drugs covered under Medicare Part B include therapies that are typically administered by a physician, either in an independent practice or hospital outpatient setting. They are not generally available at pharmacies and are not part of Medicare Part D prescription drug plans.
Under the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which was intended to promote quality and value in the American healthcare system, Congress clearly established a range of bonuses and penalties to which Medicare providers could be subjected through MIPS payment adjustments. In its 2018 Quality Payment Program final rule, CMS announced that it will immediately begin to impose these payment adjustments to Part B drug payments in addition to physicians' services under the Medicare fee schedule, a decision that represents a significant departure from current policy.
The current Part B drug payment structure already makes it difficult for certain providers (especially small and rural providers) to shoulder the financial burden of procuring and administering expensive Part B drugs. The new MIPS policy change would only exacerbate this problem, medical societies warn, by creating extreme volatility and financial uncertainty for physicians who administer these therapies.
"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. 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 states.
The letter also urges Congressional leaders to address the weighing of the MIPS cost score category.
"CMS has not outlined sound methodologies for risk adjustment for physicians with patient populations at risk for high resource use, and 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. We believe that these methodologies and measures must be developed and validated before CMS moves forward with implementing this category," the letter states.
"Taken together, these two issues could create a perfect storm for specialties whose patients depend on physician-administered drugs," the letter concludes.