Press Releases

ACR and Other Specialty Groups Pass AMA Resolution Opposing Part B Payment Demo

ATLANTA – The American College of Rheumatology (ACR) and partnering physician specialist groups today passed an American Medical Association (AMA) resolution opposing the proposed Medicare Part B payment demonstration during the AMA House of Delegates Meeting held June 11-15, 2016. The resolution states that the AMA will support and actively work to advance Congressional action to block the Medicare Part B payment demonstration in the event the Centers for Medicare and Medicaid Services (CMS) does not withdraw the demonstration.

A similar resolution authored by the American College of Rheumatology was introduced to the AMA House of Delegates by 11 national specialty provider groups, including the American College of Rheumatology, American Academy of Allergy, Asthma & Immunology, American Academy of Ophthalmology, American Association of Clinical Urologists, American College of Allergy, Asthma and immunology, American College of Gastroenterology, American Gastroenterological Association, American Society of Cataract and Refractive Surgery, and the American Society of Clinical Oncology.

“The CMS Part B payment demonstration, if not substantially modified and scaled back, would have a significant, negative impact on specialty providers and vulnerable Medicare patients. We applaud the AMA House of Delegates for passing the Part B resolution, which is an important step toward ensuring this payment proposal is not implemented as written,” said Dr. Gary Bryant, MD, FACR, chair of the ACR’s delegation to the AMA House of Delegates.

The ACR resolution outlined specialty providers’ concerns regarding the proposed Part B payment demonstration, including the fact that some specialties – such as rheumatology and gastroenterology – have very few Part B biologics available to patients, and that these therapies do not have less expensive alternatives.

Other specialties, such as ophthalmology, must have Part B drugs and biologics compounded or repackaged before they can be used to treat certain conditions. Due to new federal and state drug compounding regulations, some physicians are experiencing increased difficulty accessing compounded or repackaged drugs and biologics.

The resolution also noted that biologics and chemotherapy drugs cannot be easily switched for less expensive options. Each patient’s immunology is unique, and due to their complexity, biologics and chemotherapy drugs cannot be easily interchanged.

In the event the Part B proposal is not withdrawn by CMS, the American College of Rheumatology resolution also called for significant modifications to the proposal, including:

  • Evaluating the changes to the Part B program in a much smaller demonstration project that examines the impact on patients including the availability of high-quality and affordable services, availability of equivalent alternative therapeutic products with price differentials, average total per-patient Medicare costs by drug and average per-beneficiary cost, and phasing-in of changes to allow adjustment of operations to ensure that beneficiaries’ access to care is not disrupted;
  • Considering MACRA timeframes and changes and the impact of these changes; and
  • Establishing key exemptions to protect the most vulnerable Medicare-covered patients and providers.

Should CMS fail to respond to stakeholder input and withdraw or significantly modify the Part B drug payment demonstration project, the resolution authored by the American Society of Clinical Oncology and passed today by the AMA House of Delegates directs the AMA to support and actively work to advance Congressional action to block the demonstration if CMS proceeds with the proposal.  It also directs the AMA to advocate against policies that are likely to undermine access to the best course of treatment for individual patients and to oppose demonstration programs that could lead to lower quality of care and do not contain mechanisms for safeguarding patients.  It further directs the AMA to advocate for ensuring that CMS solicits and takes into consideration feedback from patients, physicians, advocates, or other stakeholders in a way that allows for meaningful input on any Medicare coverage or reimbursement policy that impacts patient access to medical therapies, including policies on coverage and reimbursement.

 

Erin Schmidt
703-548-0019
eschmidt@schmidtpa.com

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The American College of Rheumatology is an international medical society representing more than 9,400 rheumatologists and rheumatology health professionals with a mission to Advance Rheumatology! In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.

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