On June 15, the ACR and partnering physician specialist groups passed an American Medical Association (AMA) resolution opposing the proposed Medicare Part B drug payment demonstration during the AMA House of Delegates (HOD) meeting held June 11–15 in Chicago.
Part B Payment Demo Resolution
The resolution, which the ACR supported with the American Society of Clinical Oncology (ASCO) and other specialty groups, means the AMA will support and actively work to advance Congressional action to block the Medicare Part B payment demonstration project by CMS. A second resolution sponsored by the ACR, ASCO and the American Academy of Ophthalmology (AAO) would exempt Medicare Part B and D drug costs from resource use assessments under MACRA. If these were included without appropriate modification/risk stratification, it would create an SGR-like effect for specialties utilizing high-cost drugs, such as biologics, for our patients.
A resolution similar to that passed by the House of Delegates was authored by the ACR and introduced with 10 co-sponsoring national specialty provider groups, including the ACR, ASCO, AAO, American Academy of Allergy, Asthma & Immunology, American Association of Clinical Urologists, American College of Allergy, Asthma and Immunology, American College of Gastroenterology, American Gastroenterological Association, and the American Society of Cataract and Refractive Surgery. It 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. Each patient’s immunology is unique, and due to their complexity, biologics and chemotherapy drugs cannot be easily interchanged.
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.
In the event the Part B proposal is not withdrawn by CMS, the ACR resolution also called for significant modifications to the proposal, including: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 and CMS proceeds with the proposal, the resolution directs the AMA to support and actively work to advance Congressional action to block the demonstration. 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 affects patient access to medical therapies, including policies on coverage and reimbursement.
The ACR applauds the AMA HOD for passing the Part B resolution, which is an important step toward ensuring this payment proposal is not implemented as written.
In Other News from the HOD Meeting …
The ACR successfully co-sponsored two resolutions with various medical societies addressing changes to USP Compounding Rules and Handling of Hazardous Drugs in Healthcare Settings (USP 797 and 800) that would potentially limit our practices in the ambulatory setting.
Another resolution that was passed called gun violence a public health crisis and asked Congress to overturn legislation that blocks research on gun violence.
Andy Slavitt, acting administrator of CMS, addressed the House and said the right things about valuing physician input into everything they do, including how MACRA evolves. We need to remain vigilant and active to ensure this is a reality.
There were numerous resolutions with new policy to address the physician role in reducing opioid medication misuse, overdose and death.
The HOD also passed a revised resolution regarding Maintenance of Certification that calls for the immediate end of any secured recertifying examination that may be required by any ABMS specialty and to work with ABMS specialties to share knowledge of how alternative pathways to assess medical knowledge and ongoing learning, including CME, can replace high-stakes exams.
I attended a meeting sponsored by the Pennsylvania Medical Society (PAMED) that specifically continues to address issues with the progress or lack thereof by the ABIM to revise its recertification requirements. The PAMED Board has issued a statement of no confidence in the ABIM’s Board and leadership. As at every meeting, our delegation attended the ACP Caucus, where we heard from ACP leadership how they continue to engage ABIM in order to effect change.
Call to Action
I again encourage all ACR members to either renew their membership or join the AMA to continue to allow the ACR to leverage its advocacy activities utilizing the AMA’s ability to convene groups to address our common needs, as well as its significant advocacy activities.
“It is important to have as many avenues to advocate as possible, says ACR Government Affairs Committee Chair Will Harvey, MD, MSc, “and the AMA is a good one. More importantly, I think many of us have felt that the AMA has been more and more responsive to issues of concern to us. This year, we are in danger of losing an AMA slot because not enough of our members are also AMA members. I strongly urge you to renew with or join the AMA this year. Things are going to get worse before they get better, and we need to keep pushing AMA policy in the right direction. Regardless of how you’ve felt about them in the past, now is the time to get off the fence and join.”
We need rheumatologists to join the AMA. Having participated in your delegation for over a decade, I have seen major improvements in focus, prioritization of issues, transparency, collaboration and diversity in the AMA, and we need your help now to keep rheumatology’s seat at the table. You can help by renewing your membership in or joining the AMA. Call the AMA at 800-262-3211, and specify that you want to join or renew. We also need ACR members to specify the ACR as your specialty organization by “voting” for the ACR, which confirms for the AMA that you want to be counted toward rheumatology’s seat at the table.
Gary Bryant, MD, FACR, is chair of the ACR’s delegation to the AMA House of Delegates.