Healio Special Report: Health Care and Politics
Healio Special Report: Health Care and Politics
January 19, 2018
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ACR, medical societies urge Congress to reverse Part B change

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Angus B. Worthing

More than 100 medical societies, including the American College of Rheumatology, have urged Congress to reverse a recent CMS policy that applies Merit-based Incentive Payment System adjustments to Medicare Part B payments, warning that it will create massive financial uncertainty for specialty providers and endanger patient access.

In a letter addressed the Senate Finance on Committee, as well as the House Ways and Means and Energy and Commerce committees, the leaders of 109 medical societies argued that the new policy, included in CMS’ 2018 Quality Payment Program Final Rule, creates enormous financial risks for specialties that administer Part B drugs, jeopardizing their ability to provide the care for their patients.

“Physicians in the MIPS track will find out by June or July whether they will be receiving a positive adjustment in 2019 or a negative adjustment,” Angus B. Worthing, MD, FACP, FACR, chairman of the ACR government affairs committee, told Healio Rheumatology. “If it's a negative adjustment, then in contrast to prior years, in which only the sum of physician services was adjusted, the cost of both services and items provided, such as Part B drugs, will be adjusted.”

According to Worthing, a 5% penalty against the services provided for a year's worth of office visits for rheumatoid arthritis, which may be under $1000, would be a small penalty in comparison to a year's worth of services in addition to part B biologic drugs, which could total $10,000.

“The bottom line is that unless this new policy is not reversed by Congress now, medical practices facing a negative adjustment would be highly incentivized to stop providing Part B drugs, and patients would need to obtain the medicines at an alternate site or change to another medicine.”

The ACR and 108 other health care groups have urged Congress to promptly reverse the CMS policy linking physician payment adjustments to Part B drug costs.
Source: Architect of the Capitol 

In December, the ACR joined with 10 other specialty medical groups to warn congressional leaders against the new CMS policy implementing Merit-based Incentive Payment System (MIPS) adjustments in Medicare Part B. That warning has so far gone unheeded, ACR officials said.

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 new 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.

“This application of the adjustment is not in line with the goals of MACRA, is a significant departure from current policy and would disproportionally affect certain specialties,” the societies wrote in their most recent letter to Congress. “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.”

The groups also pointed to a new Avalere Health analysis, which reported that certain specialties that prescribe Part B drugs, including rheumatology, oncology and ophthalmology, could experience payment cuts as high as 29% if the policy remains unchanged.

“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,” the letter states. “It will significantly amplify the range of bonuses and penalties intended by MACRA, but only for certain specialties.”

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.

“Our message to lawmakers is that the train has already left the station,” David Daikh, MD, PhD, president of the ACR, said in the release. “We need Congress to put the brakes on now to avert a complete train wreck.”

The societies further argued that Part B drugs, which cannot be purchased at a pharmacy, require “the skill and knowledge of specialists to administer and monitor for adverse side effects.” The release also noted that the physician’s office is not only the most cost-effective site available for patients to receive Part B drug infusions, but is often the only available place for patients in some areas to receive such medically-necessary therapies.

“We now need Congress to act swiftly to correct this policy and ensure patients have access to all the services and treatments they need,” the letter states.  – by Jason Laday