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Editor’s note: The ACR praises Congressional leaders for passing today’s (2/9) sweeping spending agreement, which includes a technical provision reversing a Centers for Medicare & Medicaid Services (CMS) policy that would have linked physicians’ quality payment adjustments to Medicare Part B drug costs starting in 2019. The ACR also applauded the inclusion of provisions that permanently repeal Medicare caps on outpatient therapies and other rehabilitation services, repeal the Independent Payment Advisory Board (IPAB) and eliminate the Medicare Part D donut hole.
When Congress signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law in April 2015, leaders of both parties celebrated a rare bipartisan achievement. But late last year, the CMS announced a rule through MACRA’s Merit-Based Incentive Payment pathway that would both consider Medicare Part B drugs costs when determining cost scores for reimbursement, as well as apply the MIPS penalties or bonuses to reimbursements for Part B drug costs. In 2019, providers will be subject to a 4% positive or negative adjustment calculated across several categories, including cost.
The ACR and many other physician groups believe the application of the adjustment is not in line with the goals of MACRA and could make it more difficult for physicians, particularly those in small practices and in rural settings, to administer Part B medications in their communities, thus creating another patient access issue.
The ACR’s Response
The ACR is a leader of a broad coalition of provider and patient groups, also led by the American Academy of Ophthalmology (AAO) and American Society of Clinical Oncology (ASCO), pushing Congress to reverse the CMS policy. If not fixed, rheumatologists and other specialist providers could be penalized for providing Part B drugs beginning in 2019. But legislators have been reluctant to open it back up, says ACR Government Affairs Committee Chair Angus Worthing, MD, FACR, FACP.
“CMS finalized its decision to move this new policy forward in November 2017 despite strong congressional opposition,” Dr. Worthing says. “This means it will take an act of Congress to fix the problem and change CMS policy.
“That’s exactly what we’re aiming for,” he adds.
Although rheumatology is a small specialty, the ACR has taken robust leadership on this issue. For example, on Jan. 18, the ACR co-authored a letter to relevant House and Senate committee members to urge a fix.1 The ACR helped garner more than 100 organizational co-signers across the country, including the American Academy of Dermatology, American Academy of Neurology, American College of Gastroenterology, National Psoriasis Foundation, Arthritis Foundation and many others, including state and local rheumatology societies.
After a brief government shutdown in early 2018, Dr. Worthing is hopeful that a budget-neutral fix that will not penalize specialties, such as rheumatology, or limit patient access to critical drugs can be attached to the next continuing resolution (CR), which must pass by Feb. 8 to avoid another shutdown in lieu of a final budget. As of the time this article was written, the fix had not been included in the new CR package.
The CMS is analyzing MIPS data now and, by midsummer, will inform physicians whether they will see a positive or negative adjustment in 2019. Congress must act now, Dr. Worthing says, to allow the CMS to change its adjustment modeling.
“Those (clinicians) with a penalty will be highly incentivized against providing Part B drugs in the office,” says Dr. Worthing. “Their patients may be forced to receive medicines at less convenient or more expensive sites of service, or change medicines entirely.”
What You Can Do
Individual physicians can take action by contacting their elected representatives in Congress and requesting a fix. This can be achieved through a variety of means, including via the ACR’s Legislative Action Center. Rheumatologists and health professionals who are members of the ACR or ARHP may also donate to the nonpartisan lobbying arm of the ACR, RheumPAC. Additionally, Dr. Worthing says, rheumatologists can invite their Congressional delegates to their clinics—particularly those with infusion centers—so lawmakers and their staff “can see firsthand the kinds of medical services their constituents are receiving—and that they are at risk of losing.
“We think this strong chorus of voices will help push Congress to act,” Dr. Worthing says.
Kelly April Tyrrell writes about health, science and health policy. She lives in Madison, Wis.
- American College of Rheumatology. Submission to House Committee on Ways and Means and House Committee on Energy and Commerce [letter]. 2018 Jan 18.