American College of Rheumatology Backs Bill to Prevent Cuts to Infusion Reimbursement

The ACR has endorsed a proposed law that would exempt physician-administered drugs from future Medicare sequestration.

The proposed Cancer Patient Protection Act of 2013 (H.R. 1416) would impact Medicare beneficiaries with arthritis and cancer who “depend on drugs administered in their physician’s office to treat their diseases,” ACR President Audrey Uknis, MD, wrote to the bill’s sponsor in a recent letter of support.

“This is a big deal to rheumatologists and their patients who need physician-administered treatments,” adds Adam Cooper, ACR’s director of government affairs.

The bill, introduced in April by Rep. Renee Ellmers (R, NC), remains still mired in committee, but the ACR continues to push for its approval. Tim Laing, MD, chair of the ACR’s Government Affairs Committee, says the issue resonates with rheumatologists who already struggle to make ends meet with in-office treatments.“Office infusions are a small margin part of the practice with very large overhead,” he writes in an e-mail to The Rheumatologist. “You have to buy the drug and get reimbursed. A couple of bad debts can take out the margin for the year. So, sequester cuts a small margin by about a third—so your risk of loss increases.”

Prior reimbursement for in-office treatments already often fails to cover actual costs, the ACR says. The current formula for reimbursement for Medicare Part B drugs is average sales price (ASP) plus 6%. The proposed sequestration would reduce the 6% to 4.3%. That could force some providers to stop providing the treatments, while some practices reliant on the revenue stream might even have to shut down.

Dr. Laing says that if rheumatologists stop providing the treatment, it will simply disrupt continuity of care and push patients into less cost-effective settings.

“One way to mitigate the risk is to stop doing infusions and send patients to a hospital,” Dr. Laing writes. But that’s “where charges to insurance are typically higher, which means CMS pays more for the same service.”

Richard Quinn is a freelance writer in New Jersey.