Press Releases

Healthcare Groups Urge Congress to Immediately Reverse CMS Policy Linking Physician Payment Adjustments to Part B Drug Costs

Including Part B Drug Costs in MIPS Payment Adjustments Punishes Specialty Providers and Jeopardizes Patient Access to Vital Therapies, Healthcare Groups Warn

Washington, DC - More than 100 of the nation’s leading patient and provider organizations - including the American College of Rheumatology – are urging Congressional leaders to immediately reverse a new Centers for Medicare & Medicaid Services (CMS) policy that will create enormous financial uncertainty for specialty providers and jeopardize patient access to vital Part B drug therapies.

In letters sent today to leaders of the Senate Finance, House Ways & Means and House Energy & Commerce committees, healthcare groups say CMS’ recent decision to adjust providers’ reimbursements for Part B drug costs based on their performance in the Merit-Based Incentive Payment System (MIPS) creates enormous financial risk for specialties that administer Part B drugs and will lead to significant access issues for patients who rely on these therapies.

CMS included the policy change in its CY 2018 Quality Payment Program Final Rule despite repeated warnings from healthcare advocates and Congressional leaders.

“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 letters state. “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.”

According to a recent Avalere Health analysis, certain specialties that prescribe Part B drugs – including rheumatology, oncology, and ophthalmology - could see payment cuts as high as 29 percent under the policy change.

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

Healthcare groups warn that time is of the essence to reverse course on the new CMS policy since data analysis and scoring of MIPS payment adjustments have already begun. Unless Congress acts quickly, thousands of Medicare patients with autoimmune diseases, cancer, and other serious conditions will be at risk of losing access to vital Part B therapies.

“Our message to lawmakers is that the train has already left the station - we need Congress to put the brakes on now to avert a complete train wreck,” said David Daikh, MD, PhD, President of the American College of Rheumatology.

The current Part B drug payment structure already makes it difficult for providers -especially small practices and those operating in rural areas - to shoulder the financial burden of procuring and administering expensive Part B drugs, which have costs that are outside the control of the providers and which have no inexpensive alternatives. The new MIPS policy change only exacerbates this problem by creating extreme volatility and financial uncertainty for physicians who administer these therapies.

Unlike prescription drugs, Part B drugs cannot be purchased at the local pharmacy. They are complex therapies that require the skill and knowledge of specialists to administer and monitor for adverse side effects. Often, the physician’s office is not only the most cost-effective site of care for Part B drug infusions - it may be the only available place for patients in some areas to receive medically-necessary therapies.

Application of the penalties and bonuses of an incentive payment program such MACRA, which was designed to impact payments for physician services, to payments for drug costs is without precedent. Previous requests asking CMS to change course have not been heeded, leaving it up to Congress to intervene with its own correction. “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 letters conclude.

Jocelyn Givens
jgivens@rheumatology.org
404-633-3777, ext. 810

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The American College of Rheumatology (ACR) is the nation’s leading advocacy organization for the rheumatology care community, representing more than 6,400 U.S. 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.