The group also wrote that the move would “significantly and adversely exaggerate the magnitude of the bonuses and penalties provided under MIPS for medical specialties that routinely administer prescription drugs by infusion or injection,” and break from the intention of MACRA to give physicians greater control of quality care delivery. The ACR was active in educating lawmakers about the letter and asking that they sign on.
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Indeed, the CMS rule could lead to perverse incentives, says Dr. Amodeo. “If physicians know they will be penalized, this could result in access problems for patients needing expensive drugs, whereas for physicians getting the bonus, there would be the potential for substantial bonuses if they prescribe or treat patients with expensive Part B drugs.”
All Hands on Deck
The CMS is expected to release its final rule on Nov. 1, Dr. Worthing says, adding that if Part B costs remain a factor considered in payment adjustments, “then it will be critical for rheumatologists and rheumatology health professionals to tell their members of Congress to fix this problem.”
Already, the ACR has taken several significant steps to clarify or reverse the proposed rule, including submitting comments to the CMS and to the House Ways and Means Committee, signing on to a letter with the AMA and with the American Academy of Ophthalmology,5 and meeting with staff from the Ways and Means Committee and Senate Finance Committee.
“We’ve got all hands on deck, as they say,” says Dr. Worthing. “The ACR is doing everything it can to get this done. We’ve written letters, met with Congress, formed coalitions with other specialties, and we’ve generated coverage from important inside-the-beltway press that key leaders read. We also hope the AMA will help take up our cause in its November interim meeting.”
What You Can Do
Individual rheumatologists and rheumatology providers and practices should also communicate with their elected officials, Dr. Amodeo said, noting that the rule may require a statutory fix and without hearing from constituents “Congress seems very unwilling to open MACRA back up.”
Unsure how to achieve this?
“This can be as easy as sending an email through the ACR’s Legislative Action Center, sending a tweet tagging one’s representative or even setting up a meeting in the member’s district office,” says Dr. Worthing. “The ACR Executive Committee has already met with key Congressional committees that realize the importance of this problem, but input from their constituents will be critical to help break the gridlock in Washington, D.C.”