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Senate and House Leaders Urge CMS to Exclude Part B Drug Costs from MIPS Payment Adjustments

Using Part B drug spending to determine Medicare payment adjustments could significantly reduce patient access, lawmakers warn

ATLANTA – The American College of Rheumatology (ACR) today praised Senate and House leaders for urging the Centers for Medicare and Medicaid Services (CMS) to exclude Part B drug spending from the Merit-Based Incentive Payment System’s (MIPS) annual physician payment adjustments.

Led by Sens. Pat Roberts (R-KS) and Tom Carper (D-DE) in the Senate and Reps. Erik Paulsen (R-MN) and Leonard Lance (R-NJ) in the House, bipartisan groups of lawmakers from both chambers recently sent letters to Acting Health and Human Services (HHS) Secretary Eric Hargan and CMS Administrator Seema Verma urging CMS to reconsider the proposal, which lawmakers say would significantly and adversely exaggerate the magnitude of bonuses and penalties applied to specialists who administer Part B drugs.

“On the behalf of the rheumatology community, I would like to thank Congressional leaders for urging CMS to reconsider this proposal, which would create immense financial uncertainty for rheumatology providers and could significantly reduce Medicare patient access to biologic therapies administered in the outpatient setting,” said Sharad Lakhanpal, MBBS, MD, president of the ACR.

Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), eligible physicians will soon receive an adjustment to their annual Medicare reimbursements based on quality information reported to CMS. However, in the CY 2018 Quality Payment Program Proposed Rule, CMS proposed applying the MIPS payment adjustment to the cost of Part B drugs in addition to physician services.

According to a recent analysis from Avalere Health, rheumatologists could see payment variations as high as +/-16% in 2018 if Part B drug payments are included in the calculation. The same analysis found that the magnitude of risk for certain types of specialists would continue to increase over time. In performance year 2020, the payment adjustments could reach as high as +/- 29% for rheumatologists.

Including Part B drugs in MIPS payment adjustments is also a major departure from past policy as CMS has not historically included doctor-administered drug costs and other services outside the physician fee schedule in programs such as the Physician Quality Reporting System, the Medicare EHR Incentive Program, and the Value Modifier.

View the Roberts-Carper letter.

View the Paulsen-Lance letter.

CMS is expected to finalize its proposed rule in early November.

Jocelyn Givens
404-633-3777, ext. 810


The American College of Rheumatology (ACR) is the nation’s leading advocacy organization for the rheumatology care community, representing more than 9,500 rheumatologists and rheumatology health professionals. As an ethically driven, professional membership organization committed to improving healthcare for Americans living with rheumatic diseases, the ACR advocates for high-quality, high-value policies and reforms that will ensure safe, effective, affordable and accessible rheumatology care.

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