User login
Doctors to Congress: Keep Part B drug payments out of MIPS adjustment
Physician specialists are calling on Congress to isolate Medicare Part B drug reimbursements from payment adjustments under the Merit-Based Incentive Payment System (MIPS).
A coalition of medical societies, large group practices, and patient advocacy groups has asked for an “intervention this year with a technical correction that ensures the [MIPS] score adjustment is not applied to Part B drug payments,” according to Jan. 18 letter sent to the leaders of the Senate Finance Committee, House Energy and Commerce Committee, and the House Ways and Means Committee. “Since the 2018 MIPS year has begun, it is imperative that Congress acts quickly to ensure that patient access to critical treatments is not negatively impacted.”
Under MIPS, physicians are scored based on their performance across three categories: quality, improvement activities, and advancing care information. A fourth category, cost, is planned but not yet included in the score (although cost doesn’t impact adjustments until 2020, it is part of the 2018 program year). Medicare payments, which currently include Part B drug reimbursements, are subject to bonuses and penalties based on performance scores.
In their November 2017 update to the Quality Payment Program, which includes MIPS, officials at the Centers for Medicare & Medicaid Services said they would be moving forward with including Part B drug payments in the MIPS adjustment.
“This application of the adjustment ... is a significant departure from current policy and would disproportionately affect certain specialties,” according to the coalition’s letter.
Certain specialties, including rheumatology, oncology, and ophthalmology, have more to lose under the current policy because these specialists administer more Part B drugs than other specialists, according to health care consultancy Avalere Health.
For gastroenterologists, the primary concern with the application of the MIPS payment adjustment to Part B drugs is patient access to the biologics and biosimilars used to treat irritable bowel disease including Crohn’s disease and ulcerative colitis. Under CMS’s policy, gastroenterologists facing a penalty or negative payment adjustment may have Part B drug payments fall below what it costs to buy the Part B drug. Since Medicare payment for Part B drugs is based on average sales price (ASP), affected practices are more likely to be small, have a smaller number of patients on a Part B drug or prescribe a broader range of Part B drugs to patients. As MIPS payment adjustments increase each year the impact of the policy is expected to touch more practices and bring larger deficits further eroding access to the biologics and biosimilars used to treat inflammatory bowel disease.
“Certain specialists administer more Part B drugs than others and, therefore, may be exposed to significant financial risk and payment swings year-over-year under the CMS [Centers for Medicare & Medicaid Services] proposal,” John Feore, director at Avalere, said in a statement.
In 2018, physicians in those specialties could see drug payments increase or decrease by as much as 16%, according to Avalere research.
The policy likely will have an even greater effect on smaller practices and those in rural settings and could lead to access issues, according to the coalition letter.
“Some patients already face access challenges because the budget sequester has eroded reimbursements to physicians, and this policy would exacerbate these problems,” the letter states. “Patients would be left with fewer locations where they could receive care, resulting in less access and higher costs. A growing number of patients would then have to seek care in a hospital, which would result in higher out-of-pocket expenses and, particularly in rural communities, may require traveling longer distances to receive care.”
Physician specialists are calling on Congress to isolate Medicare Part B drug reimbursements from payment adjustments under the Merit-Based Incentive Payment System (MIPS).
A coalition of medical societies, large group practices, and patient advocacy groups has asked for an “intervention this year with a technical correction that ensures the [MIPS] score adjustment is not applied to Part B drug payments,” according to Jan. 18 letter sent to the leaders of the Senate Finance Committee, House Energy and Commerce Committee, and the House Ways and Means Committee. “Since the 2018 MIPS year has begun, it is imperative that Congress acts quickly to ensure that patient access to critical treatments is not negatively impacted.”
Under MIPS, physicians are scored based on their performance across three categories: quality, improvement activities, and advancing care information. A fourth category, cost, is planned but not yet included in the score (although cost doesn’t impact adjustments until 2020, it is part of the 2018 program year). Medicare payments, which currently include Part B drug reimbursements, are subject to bonuses and penalties based on performance scores.
In their November 2017 update to the Quality Payment Program, which includes MIPS, officials at the Centers for Medicare & Medicaid Services said they would be moving forward with including Part B drug payments in the MIPS adjustment.
“This application of the adjustment ... is a significant departure from current policy and would disproportionately affect certain specialties,” according to the coalition’s letter.
Certain specialties, including rheumatology, oncology, and ophthalmology, have more to lose under the current policy because these specialists administer more Part B drugs than other specialists, according to health care consultancy Avalere Health.
For gastroenterologists, the primary concern with the application of the MIPS payment adjustment to Part B drugs is patient access to the biologics and biosimilars used to treat irritable bowel disease including Crohn’s disease and ulcerative colitis. Under CMS’s policy, gastroenterologists facing a penalty or negative payment adjustment may have Part B drug payments fall below what it costs to buy the Part B drug. Since Medicare payment for Part B drugs is based on average sales price (ASP), affected practices are more likely to be small, have a smaller number of patients on a Part B drug or prescribe a broader range of Part B drugs to patients. As MIPS payment adjustments increase each year the impact of the policy is expected to touch more practices and bring larger deficits further eroding access to the biologics and biosimilars used to treat inflammatory bowel disease.
“Certain specialists administer more Part B drugs than others and, therefore, may be exposed to significant financial risk and payment swings year-over-year under the CMS [Centers for Medicare & Medicaid Services] proposal,” John Feore, director at Avalere, said in a statement.
In 2018, physicians in those specialties could see drug payments increase or decrease by as much as 16%, according to Avalere research.
The policy likely will have an even greater effect on smaller practices and those in rural settings and could lead to access issues, according to the coalition letter.
“Some patients already face access challenges because the budget sequester has eroded reimbursements to physicians, and this policy would exacerbate these problems,” the letter states. “Patients would be left with fewer locations where they could receive care, resulting in less access and higher costs. A growing number of patients would then have to seek care in a hospital, which would result in higher out-of-pocket expenses and, particularly in rural communities, may require traveling longer distances to receive care.”
Physician specialists are calling on Congress to isolate Medicare Part B drug reimbursements from payment adjustments under the Merit-Based Incentive Payment System (MIPS).
A coalition of medical societies, large group practices, and patient advocacy groups has asked for an “intervention this year with a technical correction that ensures the [MIPS] score adjustment is not applied to Part B drug payments,” according to Jan. 18 letter sent to the leaders of the Senate Finance Committee, House Energy and Commerce Committee, and the House Ways and Means Committee. “Since the 2018 MIPS year has begun, it is imperative that Congress acts quickly to ensure that patient access to critical treatments is not negatively impacted.”
Under MIPS, physicians are scored based on their performance across three categories: quality, improvement activities, and advancing care information. A fourth category, cost, is planned but not yet included in the score (although cost doesn’t impact adjustments until 2020, it is part of the 2018 program year). Medicare payments, which currently include Part B drug reimbursements, are subject to bonuses and penalties based on performance scores.
In their November 2017 update to the Quality Payment Program, which includes MIPS, officials at the Centers for Medicare & Medicaid Services said they would be moving forward with including Part B drug payments in the MIPS adjustment.
“This application of the adjustment ... is a significant departure from current policy and would disproportionately affect certain specialties,” according to the coalition’s letter.
Certain specialties, including rheumatology, oncology, and ophthalmology, have more to lose under the current policy because these specialists administer more Part B drugs than other specialists, according to health care consultancy Avalere Health.
For gastroenterologists, the primary concern with the application of the MIPS payment adjustment to Part B drugs is patient access to the biologics and biosimilars used to treat irritable bowel disease including Crohn’s disease and ulcerative colitis. Under CMS’s policy, gastroenterologists facing a penalty or negative payment adjustment may have Part B drug payments fall below what it costs to buy the Part B drug. Since Medicare payment for Part B drugs is based on average sales price (ASP), affected practices are more likely to be small, have a smaller number of patients on a Part B drug or prescribe a broader range of Part B drugs to patients. As MIPS payment adjustments increase each year the impact of the policy is expected to touch more practices and bring larger deficits further eroding access to the biologics and biosimilars used to treat inflammatory bowel disease.
“Certain specialists administer more Part B drugs than others and, therefore, may be exposed to significant financial risk and payment swings year-over-year under the CMS [Centers for Medicare & Medicaid Services] proposal,” John Feore, director at Avalere, said in a statement.
In 2018, physicians in those specialties could see drug payments increase or decrease by as much as 16%, according to Avalere research.
The policy likely will have an even greater effect on smaller practices and those in rural settings and could lead to access issues, according to the coalition letter.
“Some patients already face access challenges because the budget sequester has eroded reimbursements to physicians, and this policy would exacerbate these problems,” the letter states. “Patients would be left with fewer locations where they could receive care, resulting in less access and higher costs. A growing number of patients would then have to seek care in a hospital, which would result in higher out-of-pocket expenses and, particularly in rural communities, may require traveling longer distances to receive care.”
Health care gets little attention in State of the Union address
President Trump reaffirmed his campaign promise to lower prescription drug prices during his first State of the Union address – but gave no details on how he plans to do so.
“One of my greatest priorities is to reduce the price of prescription drugs,” President Trump said in his Jan. 30 address to a joint session of Congress. “In many other countries, these drugs cost far less than what we pay in the United States, and it is very, very unfair. That is why I have directed my administration to make fixing the injustice of high drug prices one of my top priorities for the year.”
His words followed the confirmation of Alex Azar as Health & Human Services secretary. Mr. Azar’s nomination was criticized by some who questioned whether the former president of Eli Lilly’s U.S. operations could be effective at tackling the surging prices of pharmaceuticals.
President Trump also expressed his support for allowing terminally ill patients to access experimental drugs prior to Food and Drug Administration approval, the so-called right to try.
“We also believe that patients with terminal conditions, terminal illness, should have access to experimental treatment immediately that could potentially save their lives,” he said. “People who are terminally ill should not have to go from country to country to seek a cure. I want to give them a chance right here at home. It’s time for the Congress to give these wonderful incredible Americans the right to try.”
The Senate passed a right to try bill (S. 204) in 2017 by unanimous consent, but the House has yet to act upon it.
President Trump reaffirmed his commitment to fighting the opioid epidemic and made a loose connection between it and his overall platform for immigration reform, saying that “these reforms will also support our response to the terrible crisis of opioid and drug addiction.”
As far as addressing the epidemic itself, Mr. Trump said that his administration “is committed to fighting the drug epidemic and helping get treatment for those in need, for those who have been so terribly hurt. The struggle will be long and it will be difficult, but, as Americans always do, in the end we will succeed. We will prevail.”
The president also commended Congress for effectively eliminating the Affordable Care Act’s individual mandate that required people to have health insurance or suffer a financial penalty.
President Trump reaffirmed his campaign promise to lower prescription drug prices during his first State of the Union address – but gave no details on how he plans to do so.
“One of my greatest priorities is to reduce the price of prescription drugs,” President Trump said in his Jan. 30 address to a joint session of Congress. “In many other countries, these drugs cost far less than what we pay in the United States, and it is very, very unfair. That is why I have directed my administration to make fixing the injustice of high drug prices one of my top priorities for the year.”
His words followed the confirmation of Alex Azar as Health & Human Services secretary. Mr. Azar’s nomination was criticized by some who questioned whether the former president of Eli Lilly’s U.S. operations could be effective at tackling the surging prices of pharmaceuticals.
President Trump also expressed his support for allowing terminally ill patients to access experimental drugs prior to Food and Drug Administration approval, the so-called right to try.
“We also believe that patients with terminal conditions, terminal illness, should have access to experimental treatment immediately that could potentially save their lives,” he said. “People who are terminally ill should not have to go from country to country to seek a cure. I want to give them a chance right here at home. It’s time for the Congress to give these wonderful incredible Americans the right to try.”
The Senate passed a right to try bill (S. 204) in 2017 by unanimous consent, but the House has yet to act upon it.
President Trump reaffirmed his commitment to fighting the opioid epidemic and made a loose connection between it and his overall platform for immigration reform, saying that “these reforms will also support our response to the terrible crisis of opioid and drug addiction.”
As far as addressing the epidemic itself, Mr. Trump said that his administration “is committed to fighting the drug epidemic and helping get treatment for those in need, for those who have been so terribly hurt. The struggle will be long and it will be difficult, but, as Americans always do, in the end we will succeed. We will prevail.”
The president also commended Congress for effectively eliminating the Affordable Care Act’s individual mandate that required people to have health insurance or suffer a financial penalty.
President Trump reaffirmed his campaign promise to lower prescription drug prices during his first State of the Union address – but gave no details on how he plans to do so.
“One of my greatest priorities is to reduce the price of prescription drugs,” President Trump said in his Jan. 30 address to a joint session of Congress. “In many other countries, these drugs cost far less than what we pay in the United States, and it is very, very unfair. That is why I have directed my administration to make fixing the injustice of high drug prices one of my top priorities for the year.”
His words followed the confirmation of Alex Azar as Health & Human Services secretary. Mr. Azar’s nomination was criticized by some who questioned whether the former president of Eli Lilly’s U.S. operations could be effective at tackling the surging prices of pharmaceuticals.
President Trump also expressed his support for allowing terminally ill patients to access experimental drugs prior to Food and Drug Administration approval, the so-called right to try.
“We also believe that patients with terminal conditions, terminal illness, should have access to experimental treatment immediately that could potentially save their lives,” he said. “People who are terminally ill should not have to go from country to country to seek a cure. I want to give them a chance right here at home. It’s time for the Congress to give these wonderful incredible Americans the right to try.”
The Senate passed a right to try bill (S. 204) in 2017 by unanimous consent, but the House has yet to act upon it.
President Trump reaffirmed his commitment to fighting the opioid epidemic and made a loose connection between it and his overall platform for immigration reform, saying that “these reforms will also support our response to the terrible crisis of opioid and drug addiction.”
As far as addressing the epidemic itself, Mr. Trump said that his administration “is committed to fighting the drug epidemic and helping get treatment for those in need, for those who have been so terribly hurt. The struggle will be long and it will be difficult, but, as Americans always do, in the end we will succeed. We will prevail.”
The president also commended Congress for effectively eliminating the Affordable Care Act’s individual mandate that required people to have health insurance or suffer a financial penalty.
Gleostine price hike draws fire
NextSource Pharma recently hiked the price for Gleostine (lomustine), a treatment approved for Hodgkin lymphoma and brain cancer, by 1,400%, adding it to a growing list of drugs without competition that have seen significant price increases.
In this case, the price tag for Gleostine jumped from about $50 to $786 in the 3 years since it was acquired by NextSource Pharma.
But critics point to a lack of competition as the real driver behind these types of price increases.
The Pharmaceutical Care Management Association (PCMA), the lobbying group representing pharmaceutical benefit managers, called out the NextSource Pharma and other companies that are hiking the prices of long-standing brand name drugs, saying that they are raising prices simply because they can.
“Excessive pricing is a problem,” Mark Merritt, PCMA president and CEO, said in an interview. “The Gleostine example just shows something actually pretty simple. Companies raise prices the same way, and for the same reason, that any other business does: because they have the pricing power to do it and because there is not a lot of competition to force the price down.”
Greater competition is the answer, Mr. Merritt said, and he praised recent efforts by the Food and Drug Administration in that area. For instance, FDA Commissioner Scott Gottlieb, MD, is aiming to streamline the generic drug approval process to make it less expensive and time consuming, which could bring more competitors into the marketplace, Mr. Merritt said.
The FDA has also released a list of off-patent, branded drugs without generic competition aimed at highlighting those drugs that are ripe for generic competition.
“I think when you put a watch list on that, when they know they are being watched by regulators and policy makers, that they may be called to explain their price hikes, that’s a pretty good disincentive,” Mr. Merritt said.
But one important element to building a competitive market is getting manufacturers interested in creating generic versions of a product like Gleostine, which has a small market. Mr. Merritt said that’s an issue that policymakers will have to tackle.
NextSource Pharma recently hiked the price for Gleostine (lomustine), a treatment approved for Hodgkin lymphoma and brain cancer, by 1,400%, adding it to a growing list of drugs without competition that have seen significant price increases.
In this case, the price tag for Gleostine jumped from about $50 to $786 in the 3 years since it was acquired by NextSource Pharma.
But critics point to a lack of competition as the real driver behind these types of price increases.
The Pharmaceutical Care Management Association (PCMA), the lobbying group representing pharmaceutical benefit managers, called out the NextSource Pharma and other companies that are hiking the prices of long-standing brand name drugs, saying that they are raising prices simply because they can.
“Excessive pricing is a problem,” Mark Merritt, PCMA president and CEO, said in an interview. “The Gleostine example just shows something actually pretty simple. Companies raise prices the same way, and for the same reason, that any other business does: because they have the pricing power to do it and because there is not a lot of competition to force the price down.”
Greater competition is the answer, Mr. Merritt said, and he praised recent efforts by the Food and Drug Administration in that area. For instance, FDA Commissioner Scott Gottlieb, MD, is aiming to streamline the generic drug approval process to make it less expensive and time consuming, which could bring more competitors into the marketplace, Mr. Merritt said.
The FDA has also released a list of off-patent, branded drugs without generic competition aimed at highlighting those drugs that are ripe for generic competition.
“I think when you put a watch list on that, when they know they are being watched by regulators and policy makers, that they may be called to explain their price hikes, that’s a pretty good disincentive,” Mr. Merritt said.
But one important element to building a competitive market is getting manufacturers interested in creating generic versions of a product like Gleostine, which has a small market. Mr. Merritt said that’s an issue that policymakers will have to tackle.
NextSource Pharma recently hiked the price for Gleostine (lomustine), a treatment approved for Hodgkin lymphoma and brain cancer, by 1,400%, adding it to a growing list of drugs without competition that have seen significant price increases.
In this case, the price tag for Gleostine jumped from about $50 to $786 in the 3 years since it was acquired by NextSource Pharma.
But critics point to a lack of competition as the real driver behind these types of price increases.
The Pharmaceutical Care Management Association (PCMA), the lobbying group representing pharmaceutical benefit managers, called out the NextSource Pharma and other companies that are hiking the prices of long-standing brand name drugs, saying that they are raising prices simply because they can.
“Excessive pricing is a problem,” Mark Merritt, PCMA president and CEO, said in an interview. “The Gleostine example just shows something actually pretty simple. Companies raise prices the same way, and for the same reason, that any other business does: because they have the pricing power to do it and because there is not a lot of competition to force the price down.”
Greater competition is the answer, Mr. Merritt said, and he praised recent efforts by the Food and Drug Administration in that area. For instance, FDA Commissioner Scott Gottlieb, MD, is aiming to streamline the generic drug approval process to make it less expensive and time consuming, which could bring more competitors into the marketplace, Mr. Merritt said.
The FDA has also released a list of off-patent, branded drugs without generic competition aimed at highlighting those drugs that are ripe for generic competition.
“I think when you put a watch list on that, when they know they are being watched by regulators and policy makers, that they may be called to explain their price hikes, that’s a pretty good disincentive,” Mr. Merritt said.
But one important element to building a competitive market is getting manufacturers interested in creating generic versions of a product like Gleostine, which has a small market. Mr. Merritt said that’s an issue that policymakers will have to tackle.
Alex Azar confirmed as HHS Secretary
Alex M. Azar II has been confirmed as secretary of the Department of Health & Human Services following a Jan. 24 vote in the U.S. Senate.
His nomination passed by a vote of 55-43.
Mr. Azar has previously been confirmed to two posts at HHS, first as general counsel and later as deputy HHS secretary during the administration of President George W. Bush between 2001 and 2007. Both appointments were confirmed by unanimous consent in the Senate.
Democrats on the Senate Finance Committee challenged Mr. Azar on drug prices and other issues, but their objections to his pharmaceutical industry past were not enough to stop his confirmation.
“Mr. Azar was part of this broken system [of high drug pricing], and despite the cheerful overtures that he has made to senators on the other side of the aisle over the last few weeks on how he wants to work on the issue, he has not given a single concrete example of how he would actually change the system, change the system that he said is broken,” Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) said on the Senate floor. “He won’t give us an example of how he would change it to make it better.”
In a statement, Senate Health, Education, Labor, and Pensions Chairman Lamar Alexander (R-Tenn.) said that Mr. Azar “has the broad perspective necessary to address the opioid crisis.”
However, Sen. Maggie Hassan (D-N.H.) expressed concern about whether he could effectively address the opioid epidemic.
“I was disappointed that Mr. Azar would not commit to advocating for new funding during his confirmation hearing. Considering his tenure as a top executive at a major pharmaceutical company, I also continue to have serious doubts that Mr. Azar can be a leader in addressing the skyrocketing cost of prescription drugs,” she said.
Alex M. Azar II has been confirmed as secretary of the Department of Health & Human Services following a Jan. 24 vote in the U.S. Senate.
His nomination passed by a vote of 55-43.
Mr. Azar has previously been confirmed to two posts at HHS, first as general counsel and later as deputy HHS secretary during the administration of President George W. Bush between 2001 and 2007. Both appointments were confirmed by unanimous consent in the Senate.
Democrats on the Senate Finance Committee challenged Mr. Azar on drug prices and other issues, but their objections to his pharmaceutical industry past were not enough to stop his confirmation.
“Mr. Azar was part of this broken system [of high drug pricing], and despite the cheerful overtures that he has made to senators on the other side of the aisle over the last few weeks on how he wants to work on the issue, he has not given a single concrete example of how he would actually change the system, change the system that he said is broken,” Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) said on the Senate floor. “He won’t give us an example of how he would change it to make it better.”
In a statement, Senate Health, Education, Labor, and Pensions Chairman Lamar Alexander (R-Tenn.) said that Mr. Azar “has the broad perspective necessary to address the opioid crisis.”
However, Sen. Maggie Hassan (D-N.H.) expressed concern about whether he could effectively address the opioid epidemic.
“I was disappointed that Mr. Azar would not commit to advocating for new funding during his confirmation hearing. Considering his tenure as a top executive at a major pharmaceutical company, I also continue to have serious doubts that Mr. Azar can be a leader in addressing the skyrocketing cost of prescription drugs,” she said.
Alex M. Azar II has been confirmed as secretary of the Department of Health & Human Services following a Jan. 24 vote in the U.S. Senate.
His nomination passed by a vote of 55-43.
Mr. Azar has previously been confirmed to two posts at HHS, first as general counsel and later as deputy HHS secretary during the administration of President George W. Bush between 2001 and 2007. Both appointments were confirmed by unanimous consent in the Senate.
Democrats on the Senate Finance Committee challenged Mr. Azar on drug prices and other issues, but their objections to his pharmaceutical industry past were not enough to stop his confirmation.
“Mr. Azar was part of this broken system [of high drug pricing], and despite the cheerful overtures that he has made to senators on the other side of the aisle over the last few weeks on how he wants to work on the issue, he has not given a single concrete example of how he would actually change the system, change the system that he said is broken,” Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) said on the Senate floor. “He won’t give us an example of how he would change it to make it better.”
In a statement, Senate Health, Education, Labor, and Pensions Chairman Lamar Alexander (R-Tenn.) said that Mr. Azar “has the broad perspective necessary to address the opioid crisis.”
However, Sen. Maggie Hassan (D-N.H.) expressed concern about whether he could effectively address the opioid epidemic.
“I was disappointed that Mr. Azar would not commit to advocating for new funding during his confirmation hearing. Considering his tenure as a top executive at a major pharmaceutical company, I also continue to have serious doubts that Mr. Azar can be a leader in addressing the skyrocketing cost of prescription drugs,” she said.
Doctors to Congress: Keep Part B drug payments out of MIPS adjustment
Physician specialists are calling on Congress to isolate Medicare Part B drug reimbursements from payment adjustments under the Merit-Based Incentive Payment System (MIPS).
A coalition of medical societies, large group practices, and patient advocacy groups has asked for an “intervention this year with a technical correction that ensures the [MIPS] score adjustment is not applied to Part B drug payments,” according to Jan. 18 letter sent to the leaders of the Senate Finance Committee, House Energy and Commerce Committee, and the House Ways and Means Committee. “Since the 2018 MIPS year has begun, it is imperative that Congress acts quickly to ensure that patient access to critical treatments is not negatively impacted.”
Under MIPS, physicians are scored based on their performance across three categories: quality, improvement activities, and advancing care information. A fourth category, cost, is planned but not yet included in the score. Medicare payments, which currently include Part B drug reimbursements, are subject to bonuses and penalties based on performance scores.
In their November 2017 update to the Quality Payment Program, which includes MIPS, officials at the Centers for Medicare & Medicaid Services said they would be moving forward with including Part B drug payments in the MIPS adjustment.
“This application of the adjustment ... is a significant departure from current policy and would disproportionately affect certain specialties,” according to the coalition’s letter.
Certain specialties, including rheumatology, oncology, and ophthalmology, have more to lose under the current policy because these specialists administer more Part B drugs than other specialists, according to health care consultancy Avalere Health.
“Certain specialists administer more Part B drugs than others and, therefore, may be exposed to significant financial risk and payment swings year-over-year under the CMS [Centers for Medicare & Medicaid Services] proposal,” John Feore, director at Avalere, said in a statement.
In 2018, physicians in those specialties could see drug payments increase or decrease by as much as 16%, according to Avalere research.
The policy likely will have an even greater effect on smaller practices and those in rural settings and could lead to access issues, according to the coalition letter.
“Some patients already face access challenges because the budget sequester has eroded reimbursements to physicians, and this policy would exacerbate these problems,” the letter states. “Patients would be left with fewer locations where they could receive care, resulting in less access and higher costs. A growing number of patients would then have to seek care in a hospital, which would result in higher out-of-pocket expenses and, particularly in rural communities, may require traveling longer distances to receive care.”
Physician specialists are calling on Congress to isolate Medicare Part B drug reimbursements from payment adjustments under the Merit-Based Incentive Payment System (MIPS).
A coalition of medical societies, large group practices, and patient advocacy groups has asked for an “intervention this year with a technical correction that ensures the [MIPS] score adjustment is not applied to Part B drug payments,” according to Jan. 18 letter sent to the leaders of the Senate Finance Committee, House Energy and Commerce Committee, and the House Ways and Means Committee. “Since the 2018 MIPS year has begun, it is imperative that Congress acts quickly to ensure that patient access to critical treatments is not negatively impacted.”
Under MIPS, physicians are scored based on their performance across three categories: quality, improvement activities, and advancing care information. A fourth category, cost, is planned but not yet included in the score. Medicare payments, which currently include Part B drug reimbursements, are subject to bonuses and penalties based on performance scores.
In their November 2017 update to the Quality Payment Program, which includes MIPS, officials at the Centers for Medicare & Medicaid Services said they would be moving forward with including Part B drug payments in the MIPS adjustment.
“This application of the adjustment ... is a significant departure from current policy and would disproportionately affect certain specialties,” according to the coalition’s letter.
Certain specialties, including rheumatology, oncology, and ophthalmology, have more to lose under the current policy because these specialists administer more Part B drugs than other specialists, according to health care consultancy Avalere Health.
“Certain specialists administer more Part B drugs than others and, therefore, may be exposed to significant financial risk and payment swings year-over-year under the CMS [Centers for Medicare & Medicaid Services] proposal,” John Feore, director at Avalere, said in a statement.
In 2018, physicians in those specialties could see drug payments increase or decrease by as much as 16%, according to Avalere research.
The policy likely will have an even greater effect on smaller practices and those in rural settings and could lead to access issues, according to the coalition letter.
“Some patients already face access challenges because the budget sequester has eroded reimbursements to physicians, and this policy would exacerbate these problems,” the letter states. “Patients would be left with fewer locations where they could receive care, resulting in less access and higher costs. A growing number of patients would then have to seek care in a hospital, which would result in higher out-of-pocket expenses and, particularly in rural communities, may require traveling longer distances to receive care.”
Physician specialists are calling on Congress to isolate Medicare Part B drug reimbursements from payment adjustments under the Merit-Based Incentive Payment System (MIPS).
A coalition of medical societies, large group practices, and patient advocacy groups has asked for an “intervention this year with a technical correction that ensures the [MIPS] score adjustment is not applied to Part B drug payments,” according to Jan. 18 letter sent to the leaders of the Senate Finance Committee, House Energy and Commerce Committee, and the House Ways and Means Committee. “Since the 2018 MIPS year has begun, it is imperative that Congress acts quickly to ensure that patient access to critical treatments is not negatively impacted.”
Under MIPS, physicians are scored based on their performance across three categories: quality, improvement activities, and advancing care information. A fourth category, cost, is planned but not yet included in the score. Medicare payments, which currently include Part B drug reimbursements, are subject to bonuses and penalties based on performance scores.
In their November 2017 update to the Quality Payment Program, which includes MIPS, officials at the Centers for Medicare & Medicaid Services said they would be moving forward with including Part B drug payments in the MIPS adjustment.
“This application of the adjustment ... is a significant departure from current policy and would disproportionately affect certain specialties,” according to the coalition’s letter.
Certain specialties, including rheumatology, oncology, and ophthalmology, have more to lose under the current policy because these specialists administer more Part B drugs than other specialists, according to health care consultancy Avalere Health.
“Certain specialists administer more Part B drugs than others and, therefore, may be exposed to significant financial risk and payment swings year-over-year under the CMS [Centers for Medicare & Medicaid Services] proposal,” John Feore, director at Avalere, said in a statement.
In 2018, physicians in those specialties could see drug payments increase or decrease by as much as 16%, according to Avalere research.
The policy likely will have an even greater effect on smaller practices and those in rural settings and could lead to access issues, according to the coalition letter.
“Some patients already face access challenges because the budget sequester has eroded reimbursements to physicians, and this policy would exacerbate these problems,” the letter states. “Patients would be left with fewer locations where they could receive care, resulting in less access and higher costs. A growing number of patients would then have to seek care in a hospital, which would result in higher out-of-pocket expenses and, particularly in rural communities, may require traveling longer distances to receive care.”
CHIP gets a 6-year extension in stopgap budget
The legislation did not address two Affordable Care Act provisions that have been bandied about in this years’ budget debacle – delaying the “Cadillac tax” on high-valued employer health insurance plans and the medical device tax.
The short-term funding bill (H.R. 195) passed the Senate by an 81-18 vote and the House by a 266-150 vote after a 3-day shutdown of the federal government driven primarily by partisan disagreement over immigration policy.
CHIP funding had expired at the end of September 2017. The 6-year reauthorization period is the longest since the program was created in 1997. The Senate Finance Committee passed a bill reauthorizing CHIP for 5 years in October 2017, but the Senate did not take any action.
Although he voted for the 6-year extension, Sen. Ben Cardin (D-Md.) said that Congress was going only for a temporary extension rather than making CHIP a permanent program.
“I wish it were permanent,” Sen. Cardin said on the Senate floor. “Rather than putting another deadline on the program, we should try to make this permanent.”
Sen. Cardin also said the bill did nothing to extend funding to community health centers, where many children covered by CHIP get their medical treatments.
The legislation did not address two Affordable Care Act provisions that have been bandied about in this years’ budget debacle – delaying the “Cadillac tax” on high-valued employer health insurance plans and the medical device tax.
The short-term funding bill (H.R. 195) passed the Senate by an 81-18 vote and the House by a 266-150 vote after a 3-day shutdown of the federal government driven primarily by partisan disagreement over immigration policy.
CHIP funding had expired at the end of September 2017. The 6-year reauthorization period is the longest since the program was created in 1997. The Senate Finance Committee passed a bill reauthorizing CHIP for 5 years in October 2017, but the Senate did not take any action.
Although he voted for the 6-year extension, Sen. Ben Cardin (D-Md.) said that Congress was going only for a temporary extension rather than making CHIP a permanent program.
“I wish it were permanent,” Sen. Cardin said on the Senate floor. “Rather than putting another deadline on the program, we should try to make this permanent.”
Sen. Cardin also said the bill did nothing to extend funding to community health centers, where many children covered by CHIP get their medical treatments.
The legislation did not address two Affordable Care Act provisions that have been bandied about in this years’ budget debacle – delaying the “Cadillac tax” on high-valued employer health insurance plans and the medical device tax.
The short-term funding bill (H.R. 195) passed the Senate by an 81-18 vote and the House by a 266-150 vote after a 3-day shutdown of the federal government driven primarily by partisan disagreement over immigration policy.
CHIP funding had expired at the end of September 2017. The 6-year reauthorization period is the longest since the program was created in 1997. The Senate Finance Committee passed a bill reauthorizing CHIP for 5 years in October 2017, but the Senate did not take any action.
Although he voted for the 6-year extension, Sen. Ben Cardin (D-Md.) said that Congress was going only for a temporary extension rather than making CHIP a permanent program.
“I wish it were permanent,” Sen. Cardin said on the Senate floor. “Rather than putting another deadline on the program, we should try to make this permanent.”
Sen. Cardin also said the bill did nothing to extend funding to community health centers, where many children covered by CHIP get their medical treatments.
CHIP out of cash amid government shutdown
The Children’s Health Insurance Plan remains without funding as a temporary government funding bill that included a 6-year extension of the popular bipartisan program failed to garner enough support in the Senate.
On Jan. 19, to clear that hurdle.
Other Republican senators who voted against the bill were Jeff Flake of Arizona, Lindsey Graham of South Carolina, Mike Lee of Utah, and Rand Paul of Kentucky.
Democratic senators who voted for the bill were Joe Donnelly of Indiana, Heidi Heitkamp of North Dakota, Doug Jones of Alabama, Joe Manchin of West Virginia, and Claire McCaskill of Missouri.
The continuing resolution also featured a few other health care provisions, including delays to the medical device tax and the so-called Cadillac tax on high-valued health insurance plans offered by employers.
In comments made on the Senate floor prior to the vote, Finance Committee Chairman Orrin Hatch (R-Utah) called out Democrats for failing to pass the bill.
“There’s really nothing wrong with the substance of the bill, Mr. President, or at least very few of our Democratic colleagues are complaining about what’s actually in the bill” he said. “Instead, they’re complaining about what’s not in it.”
Democrats made their stand on the absence of language on Deferred Action for Childhood Arrivals (DACA), which addresses the immigration status of young people – often called Dreamers – who were brought to this country illegally as children.
Democrats also complained that funding for community health centers was not included.
Sen. Hatch, one of the original authors of the CHIP authorizing legislation, continued to argue for the program and the overall funding bill.
“This new bill before us would reauthorize CHIP for 6 six years,” he noted. “A 6-year extension would be the longest in the history of the program. In all other respects, the bill is identical to the one the Finance Committee reported [in September] with broad bipartisan support,” although no further action was taken on it after receiving near unanimous support in committee.
Finance Committee Ranking Member Ron Wyden (D-Ore.) took exception to the characterization that Democrats were not in support of the CHIP provision.
“The Chairman and I did negotiate a CHIP extension back in September, and the Senate Finance did report it out in a near unanimous, bipartisan basis,” he said. “CHIP could have passed the Congress within days, but the House Republicans had other ideas.”
Sen. Wyden noted that CHIP reauthorization was attached to other legislative actions in the House that all failed to garner enough support instead of being sent through as a stand-alone bill that likely would have received large bipartisan support.
And even though the extension would be for 6 years, Sen. Wyden also questioned why it wasn’t receiving permanent authorization.
“Congress learned that making CHIP permanent actually saves taxpayer dollars,” he said. “It’s a better deal than a 6-year extension, less of an expense for the taxpayer. True fiscal conservatives ought to be tripping over themselves to pass a permanent bill without preconditions. But at every turn in the CHIP debate, Republican leaders have found a new hostage.”
Sen. McConnell said following the failed voted that the Senate would resume activities beginning at noon on Jan. 20 – with votes expected – in hopes of finding a solution.
The Children’s Health Insurance Plan remains without funding as a temporary government funding bill that included a 6-year extension of the popular bipartisan program failed to garner enough support in the Senate.
On Jan. 19, to clear that hurdle.
Other Republican senators who voted against the bill were Jeff Flake of Arizona, Lindsey Graham of South Carolina, Mike Lee of Utah, and Rand Paul of Kentucky.
Democratic senators who voted for the bill were Joe Donnelly of Indiana, Heidi Heitkamp of North Dakota, Doug Jones of Alabama, Joe Manchin of West Virginia, and Claire McCaskill of Missouri.
The continuing resolution also featured a few other health care provisions, including delays to the medical device tax and the so-called Cadillac tax on high-valued health insurance plans offered by employers.
In comments made on the Senate floor prior to the vote, Finance Committee Chairman Orrin Hatch (R-Utah) called out Democrats for failing to pass the bill.
“There’s really nothing wrong with the substance of the bill, Mr. President, or at least very few of our Democratic colleagues are complaining about what’s actually in the bill” he said. “Instead, they’re complaining about what’s not in it.”
Democrats made their stand on the absence of language on Deferred Action for Childhood Arrivals (DACA), which addresses the immigration status of young people – often called Dreamers – who were brought to this country illegally as children.
Democrats also complained that funding for community health centers was not included.
Sen. Hatch, one of the original authors of the CHIP authorizing legislation, continued to argue for the program and the overall funding bill.
“This new bill before us would reauthorize CHIP for 6 six years,” he noted. “A 6-year extension would be the longest in the history of the program. In all other respects, the bill is identical to the one the Finance Committee reported [in September] with broad bipartisan support,” although no further action was taken on it after receiving near unanimous support in committee.
Finance Committee Ranking Member Ron Wyden (D-Ore.) took exception to the characterization that Democrats were not in support of the CHIP provision.
“The Chairman and I did negotiate a CHIP extension back in September, and the Senate Finance did report it out in a near unanimous, bipartisan basis,” he said. “CHIP could have passed the Congress within days, but the House Republicans had other ideas.”
Sen. Wyden noted that CHIP reauthorization was attached to other legislative actions in the House that all failed to garner enough support instead of being sent through as a stand-alone bill that likely would have received large bipartisan support.
And even though the extension would be for 6 years, Sen. Wyden also questioned why it wasn’t receiving permanent authorization.
“Congress learned that making CHIP permanent actually saves taxpayer dollars,” he said. “It’s a better deal than a 6-year extension, less of an expense for the taxpayer. True fiscal conservatives ought to be tripping over themselves to pass a permanent bill without preconditions. But at every turn in the CHIP debate, Republican leaders have found a new hostage.”
Sen. McConnell said following the failed voted that the Senate would resume activities beginning at noon on Jan. 20 – with votes expected – in hopes of finding a solution.
The Children’s Health Insurance Plan remains without funding as a temporary government funding bill that included a 6-year extension of the popular bipartisan program failed to garner enough support in the Senate.
On Jan. 19, to clear that hurdle.
Other Republican senators who voted against the bill were Jeff Flake of Arizona, Lindsey Graham of South Carolina, Mike Lee of Utah, and Rand Paul of Kentucky.
Democratic senators who voted for the bill were Joe Donnelly of Indiana, Heidi Heitkamp of North Dakota, Doug Jones of Alabama, Joe Manchin of West Virginia, and Claire McCaskill of Missouri.
The continuing resolution also featured a few other health care provisions, including delays to the medical device tax and the so-called Cadillac tax on high-valued health insurance plans offered by employers.
In comments made on the Senate floor prior to the vote, Finance Committee Chairman Orrin Hatch (R-Utah) called out Democrats for failing to pass the bill.
“There’s really nothing wrong with the substance of the bill, Mr. President, or at least very few of our Democratic colleagues are complaining about what’s actually in the bill” he said. “Instead, they’re complaining about what’s not in it.”
Democrats made their stand on the absence of language on Deferred Action for Childhood Arrivals (DACA), which addresses the immigration status of young people – often called Dreamers – who were brought to this country illegally as children.
Democrats also complained that funding for community health centers was not included.
Sen. Hatch, one of the original authors of the CHIP authorizing legislation, continued to argue for the program and the overall funding bill.
“This new bill before us would reauthorize CHIP for 6 six years,” he noted. “A 6-year extension would be the longest in the history of the program. In all other respects, the bill is identical to the one the Finance Committee reported [in September] with broad bipartisan support,” although no further action was taken on it after receiving near unanimous support in committee.
Finance Committee Ranking Member Ron Wyden (D-Ore.) took exception to the characterization that Democrats were not in support of the CHIP provision.
“The Chairman and I did negotiate a CHIP extension back in September, and the Senate Finance did report it out in a near unanimous, bipartisan basis,” he said. “CHIP could have passed the Congress within days, but the House Republicans had other ideas.”
Sen. Wyden noted that CHIP reauthorization was attached to other legislative actions in the House that all failed to garner enough support instead of being sent through as a stand-alone bill that likely would have received large bipartisan support.
And even though the extension would be for 6 years, Sen. Wyden also questioned why it wasn’t receiving permanent authorization.
“Congress learned that making CHIP permanent actually saves taxpayer dollars,” he said. “It’s a better deal than a 6-year extension, less of an expense for the taxpayer. True fiscal conservatives ought to be tripping over themselves to pass a permanent bill without preconditions. But at every turn in the CHIP debate, Republican leaders have found a new hostage.”
Sen. McConnell said following the failed voted that the Senate would resume activities beginning at noon on Jan. 20 – with votes expected – in hopes of finding a solution.
Finance Committee votes on Azar HHS nomination
With a Senate Finance Committee vote of 15 to 12, Alex Azar’s nomination for secretary of Health & Human Services has been sent to the full Senate for consideration.
Finance Committee Chairman Orrin Hatch (R-Utah) said at a Jan. 17 hearing that “by any objective account, Mr. Azar is very well qualified for this important position. He has close to two decades of experience, the right expertise, and sound judgment.”
Most recently, Mr. Azar served as president of Eli Lilly’s U.S. operations from 2012 to 2017 after joining the company in 2007. His drug industry ties have raised concerns that the agency’s regulatory actions would be favorable to pharmaceutical manufacturers at the expense of patients. However, at his confirmation hearing, Mr. Azar noted that he would be willing to investigate government drug price negotiations for Medicare Part B drugs.
The top Democrat on the Finance Committee, Sen. Ron Wyden (D-Ore.) voted against Mr. Azar’s nomination, noting that President Trump “famously said, his words, in the 2016 campaign, ‘price-hiking drug companies were getting away with murder.’ The President has now nominated a drug company executive with a documented history of raising drug prices.”
Sen. Wyden noted that prices of many commonly prescribed drugs “more than doubled under [Mr. Azar’s] watch” while no drugs saw a decline in pricing.
With a Senate Finance Committee vote of 15 to 12, Alex Azar’s nomination for secretary of Health & Human Services has been sent to the full Senate for consideration.
Finance Committee Chairman Orrin Hatch (R-Utah) said at a Jan. 17 hearing that “by any objective account, Mr. Azar is very well qualified for this important position. He has close to two decades of experience, the right expertise, and sound judgment.”
Most recently, Mr. Azar served as president of Eli Lilly’s U.S. operations from 2012 to 2017 after joining the company in 2007. His drug industry ties have raised concerns that the agency’s regulatory actions would be favorable to pharmaceutical manufacturers at the expense of patients. However, at his confirmation hearing, Mr. Azar noted that he would be willing to investigate government drug price negotiations for Medicare Part B drugs.
The top Democrat on the Finance Committee, Sen. Ron Wyden (D-Ore.) voted against Mr. Azar’s nomination, noting that President Trump “famously said, his words, in the 2016 campaign, ‘price-hiking drug companies were getting away with murder.’ The President has now nominated a drug company executive with a documented history of raising drug prices.”
Sen. Wyden noted that prices of many commonly prescribed drugs “more than doubled under [Mr. Azar’s] watch” while no drugs saw a decline in pricing.
With a Senate Finance Committee vote of 15 to 12, Alex Azar’s nomination for secretary of Health & Human Services has been sent to the full Senate for consideration.
Finance Committee Chairman Orrin Hatch (R-Utah) said at a Jan. 17 hearing that “by any objective account, Mr. Azar is very well qualified for this important position. He has close to two decades of experience, the right expertise, and sound judgment.”
Most recently, Mr. Azar served as president of Eli Lilly’s U.S. operations from 2012 to 2017 after joining the company in 2007. His drug industry ties have raised concerns that the agency’s regulatory actions would be favorable to pharmaceutical manufacturers at the expense of patients. However, at his confirmation hearing, Mr. Azar noted that he would be willing to investigate government drug price negotiations for Medicare Part B drugs.
The top Democrat on the Finance Committee, Sen. Ron Wyden (D-Ore.) voted against Mr. Azar’s nomination, noting that President Trump “famously said, his words, in the 2016 campaign, ‘price-hiking drug companies were getting away with murder.’ The President has now nominated a drug company executive with a documented history of raising drug prices.”
Sen. Wyden noted that prices of many commonly prescribed drugs “more than doubled under [Mr. Azar’s] watch” while no drugs saw a decline in pricing.
REPORTING FROM A SENATE FINANCE COMMITTEE HEARING
MedPAC recommends scrapping MIPS, gets pushback from doctors
WASHINGTON – As unpopular as the new Quality Payment Program may be, repealing all or part of it at this stage will be a tough sell.
That was the message heard by members of the Medicare Payment Advisory Commission (MedPAC) during public comments at their Jan. 11 meeting. Comments followed a 14-2 vote by commissioners in favor of recommending that Congress scrap the Merit-Based Incentive Payment System (MIPS) track of the QPP.
“We do agree that there are problems with MIPS,” said Sharon McIlrath, assistant director of federal affairs and coalitions at the American Medical Association. “We would like to fix it rather than kill it, and partly that’s because we don’t want to send shifting messages to physicians. Are they going to invest in building an infrastructure on shifting ground?”
She also questioned whether this proposal could gain any traction at all in Congress.
“We don’t think that it is politically viable to think that you are going to go up there and get the Hill to kill MIPS,” she said.
The Alliance of Specialty Medicine in a Jan. 9 letter to MedPAC also voiced its objections to the commission’s plan to recommend the end of MIPS.
“Our efforts to work with CMS and congressional leaders to improve MIPS and allow for more meaningful and robust engagement are ongoing. We urge you to withdraw your forthcoming recommendation, which diminishes the important role of specialty medicine in Medicare,” alliance members wrote to MedPAC Chairman Francis J. Crosson, MD. “Instead, the commission and staff, under your leadership, should work toward a new recommendation that would improve aspects of the MIPS program that remain a challenge for all clinicians.”
MedPAC had been working on its recommendations regarding MIPS since the program was launched, but ultimately came to the conclusion that it was not fixable. During a presentation on the draft recommendation, MedPAC staff listed a variety of reasons why MIPS “cannot succeed,” including how it replicates flaws of previous value-based purchasing plans and is burdensome and complex, the information reported is not meaningful, scores are not comparable across clinicians, and the payment adjustments, while minimal early on, could vary widely from year to year with even the smallest of MIPS score changes.
Instead, current draft MedPAC recommendations put forward a voluntary value program (VVP) to replace MIPS. VVP would withhold a specific percentage of Medicare pay for physicians who are not involved in a QPP advanced Alternative Payment Model (APM).
Physicians would be able to earn back the withheld pay, plus be eligible for potential bonuses by voluntarily participating in virtual groups. Those groups would be scored on population-based measures.
As was the case across previous meetings where this was discussed, commissioners David Nerenz, PhD, of the Henry Ford Health System of Detroit, and Alice Coombs, MD, of South Shore Hospital, Weymouth, Mass., continued to voice their objections about repealing MIPS and ultimately voted against the recommendation.
The MIPS recommendation will be included in MedPAC’s June report to Congress; it then will be up to Congress to decide whether to act on it.
WASHINGTON – As unpopular as the new Quality Payment Program may be, repealing all or part of it at this stage will be a tough sell.
That was the message heard by members of the Medicare Payment Advisory Commission (MedPAC) during public comments at their Jan. 11 meeting. Comments followed a 14-2 vote by commissioners in favor of recommending that Congress scrap the Merit-Based Incentive Payment System (MIPS) track of the QPP.
“We do agree that there are problems with MIPS,” said Sharon McIlrath, assistant director of federal affairs and coalitions at the American Medical Association. “We would like to fix it rather than kill it, and partly that’s because we don’t want to send shifting messages to physicians. Are they going to invest in building an infrastructure on shifting ground?”
She also questioned whether this proposal could gain any traction at all in Congress.
“We don’t think that it is politically viable to think that you are going to go up there and get the Hill to kill MIPS,” she said.
The Alliance of Specialty Medicine in a Jan. 9 letter to MedPAC also voiced its objections to the commission’s plan to recommend the end of MIPS.
“Our efforts to work with CMS and congressional leaders to improve MIPS and allow for more meaningful and robust engagement are ongoing. We urge you to withdraw your forthcoming recommendation, which diminishes the important role of specialty medicine in Medicare,” alliance members wrote to MedPAC Chairman Francis J. Crosson, MD. “Instead, the commission and staff, under your leadership, should work toward a new recommendation that would improve aspects of the MIPS program that remain a challenge for all clinicians.”
MedPAC had been working on its recommendations regarding MIPS since the program was launched, but ultimately came to the conclusion that it was not fixable. During a presentation on the draft recommendation, MedPAC staff listed a variety of reasons why MIPS “cannot succeed,” including how it replicates flaws of previous value-based purchasing plans and is burdensome and complex, the information reported is not meaningful, scores are not comparable across clinicians, and the payment adjustments, while minimal early on, could vary widely from year to year with even the smallest of MIPS score changes.
Instead, current draft MedPAC recommendations put forward a voluntary value program (VVP) to replace MIPS. VVP would withhold a specific percentage of Medicare pay for physicians who are not involved in a QPP advanced Alternative Payment Model (APM).
Physicians would be able to earn back the withheld pay, plus be eligible for potential bonuses by voluntarily participating in virtual groups. Those groups would be scored on population-based measures.
As was the case across previous meetings where this was discussed, commissioners David Nerenz, PhD, of the Henry Ford Health System of Detroit, and Alice Coombs, MD, of South Shore Hospital, Weymouth, Mass., continued to voice their objections about repealing MIPS and ultimately voted against the recommendation.
The MIPS recommendation will be included in MedPAC’s June report to Congress; it then will be up to Congress to decide whether to act on it.
WASHINGTON – As unpopular as the new Quality Payment Program may be, repealing all or part of it at this stage will be a tough sell.
That was the message heard by members of the Medicare Payment Advisory Commission (MedPAC) during public comments at their Jan. 11 meeting. Comments followed a 14-2 vote by commissioners in favor of recommending that Congress scrap the Merit-Based Incentive Payment System (MIPS) track of the QPP.
“We do agree that there are problems with MIPS,” said Sharon McIlrath, assistant director of federal affairs and coalitions at the American Medical Association. “We would like to fix it rather than kill it, and partly that’s because we don’t want to send shifting messages to physicians. Are they going to invest in building an infrastructure on shifting ground?”
She also questioned whether this proposal could gain any traction at all in Congress.
“We don’t think that it is politically viable to think that you are going to go up there and get the Hill to kill MIPS,” she said.
The Alliance of Specialty Medicine in a Jan. 9 letter to MedPAC also voiced its objections to the commission’s plan to recommend the end of MIPS.
“Our efforts to work with CMS and congressional leaders to improve MIPS and allow for more meaningful and robust engagement are ongoing. We urge you to withdraw your forthcoming recommendation, which diminishes the important role of specialty medicine in Medicare,” alliance members wrote to MedPAC Chairman Francis J. Crosson, MD. “Instead, the commission and staff, under your leadership, should work toward a new recommendation that would improve aspects of the MIPS program that remain a challenge for all clinicians.”
MedPAC had been working on its recommendations regarding MIPS since the program was launched, but ultimately came to the conclusion that it was not fixable. During a presentation on the draft recommendation, MedPAC staff listed a variety of reasons why MIPS “cannot succeed,” including how it replicates flaws of previous value-based purchasing plans and is burdensome and complex, the information reported is not meaningful, scores are not comparable across clinicians, and the payment adjustments, while minimal early on, could vary widely from year to year with even the smallest of MIPS score changes.
Instead, current draft MedPAC recommendations put forward a voluntary value program (VVP) to replace MIPS. VVP would withhold a specific percentage of Medicare pay for physicians who are not involved in a QPP advanced Alternative Payment Model (APM).
Physicians would be able to earn back the withheld pay, plus be eligible for potential bonuses by voluntarily participating in virtual groups. Those groups would be scored on population-based measures.
As was the case across previous meetings where this was discussed, commissioners David Nerenz, PhD, of the Henry Ford Health System of Detroit, and Alice Coombs, MD, of South Shore Hospital, Weymouth, Mass., continued to voice their objections about repealing MIPS and ultimately voted against the recommendation.
The MIPS recommendation will be included in MedPAC’s June report to Congress; it then will be up to Congress to decide whether to act on it.
REPORTING FROM A MEDPAC MEETING
Waiving Medicare coinsurance for positive colorectal screening likely beneficial
Currently, Medicare covers colorectal screening at no charge to the patient, but if a polyp is removed upon discovery during the procedure, the patient would then be subject to Medicare’s coinsurance payments for both the colonoscopy and the removal.
Researchers used the Microsimulation Screening Analysis-Colon model to estimate the cost-effectiveness of waiving coinsurance for every component of colorectal cancer screening. They estimated that, currently, using the colonoscopy regimen with coinsurance, 12.8 colorectal cancer deaths occurred per 1,000 people aged 65 years and 124.1 QALYs were gained per 1,000 people aged 65 years. The total number of procedures per 1,000 Medicare beneficiaries was 1,132, of which 410 (36%) were potentially subject to coinsurance requirements.
“We estimated that the total lifetime costs for [the Centers for Medicare & Medicaid], which included colorectal cancer screening, surveillance, and treatment with coinsurance, to be $2.675 million per 1,000 sixty-five-year-olds,” Ms. Peterse and her colleagues wrote.
Researchers noted that if the coinsurance was waived but there was no follow-on increase in the screening rate, the benefits of screening would not change but the total cost of screening and treatment would increase to $2.726 million per 1,000 people aged 65 years.
However, “an assumed 5-percentage-point increase in the rates of first colonoscopy screening and surveillance decreased the number of colorectal cancer deaths by 0.9 (6.4 percent), accompanied by an increase of $33,000 (1.2 percent) in total costs, with a cost per QALY gained (or cost-effectiveness ratio) of $4,086.”
They added that estimated screening benefits were similar when fecal testing was the primary screening method.
“In general, [fecal testing] screening was associated with lower number of procedures subject to coinsurance,” the researchers added. “If [fecal testing] screening becomes more popular in the United States, following trends observed in several settings, the costs of waiving coinsurance would be even lower.” The researchers also suggest that it could lead to reducing disparities of colorectal cancer in the United States as well.
AGA has been working for years to try to fix this issue, and supports the bipartisan Removing Barriers to Screening Act, which would correct this inequity for Medicare beneficiaries and remove the financial barriers that may prevent a patient from undergoing a screening. AGA is hopeful that the growing support for the legislation on both sides of the aisle will help get the bill passed this year. To learn more about this issue, visit http://www.gastro.org/take-action/top-issues/patient-cost-sharing-for-screening-colonoscopy. To help your patient understand this issue, AGA has created “What to Expect: Paying for Your Colonoscopy,” which can be downloaded at http://www.gastro.org/patient-care/procedures/Colonoscopy_CoPay_WhatToKnowFactSheet.pdf to be shared in your office. /p>
gtwachtman@frontlinemedcom.com
SOURCE: Peterse EFP et al. Health Affairs. 2017 Dec;36(12):2151-9.
Currently, Medicare covers colorectal screening at no charge to the patient, but if a polyp is removed upon discovery during the procedure, the patient would then be subject to Medicare’s coinsurance payments for both the colonoscopy and the removal.
Researchers used the Microsimulation Screening Analysis-Colon model to estimate the cost-effectiveness of waiving coinsurance for every component of colorectal cancer screening. They estimated that, currently, using the colonoscopy regimen with coinsurance, 12.8 colorectal cancer deaths occurred per 1,000 people aged 65 years and 124.1 QALYs were gained per 1,000 people aged 65 years. The total number of procedures per 1,000 Medicare beneficiaries was 1,132, of which 410 (36%) were potentially subject to coinsurance requirements.
“We estimated that the total lifetime costs for [the Centers for Medicare & Medicaid], which included colorectal cancer screening, surveillance, and treatment with coinsurance, to be $2.675 million per 1,000 sixty-five-year-olds,” Ms. Peterse and her colleagues wrote.
Researchers noted that if the coinsurance was waived but there was no follow-on increase in the screening rate, the benefits of screening would not change but the total cost of screening and treatment would increase to $2.726 million per 1,000 people aged 65 years.
However, “an assumed 5-percentage-point increase in the rates of first colonoscopy screening and surveillance decreased the number of colorectal cancer deaths by 0.9 (6.4 percent), accompanied by an increase of $33,000 (1.2 percent) in total costs, with a cost per QALY gained (or cost-effectiveness ratio) of $4,086.”
They added that estimated screening benefits were similar when fecal testing was the primary screening method.
“In general, [fecal testing] screening was associated with lower number of procedures subject to coinsurance,” the researchers added. “If [fecal testing] screening becomes more popular in the United States, following trends observed in several settings, the costs of waiving coinsurance would be even lower.” The researchers also suggest that it could lead to reducing disparities of colorectal cancer in the United States as well.
AGA has been working for years to try to fix this issue, and supports the bipartisan Removing Barriers to Screening Act, which would correct this inequity for Medicare beneficiaries and remove the financial barriers that may prevent a patient from undergoing a screening. AGA is hopeful that the growing support for the legislation on both sides of the aisle will help get the bill passed this year. To learn more about this issue, visit http://www.gastro.org/take-action/top-issues/patient-cost-sharing-for-screening-colonoscopy. To help your patient understand this issue, AGA has created “What to Expect: Paying for Your Colonoscopy,” which can be downloaded at http://www.gastro.org/patient-care/procedures/Colonoscopy_CoPay_WhatToKnowFactSheet.pdf to be shared in your office. /p>
gtwachtman@frontlinemedcom.com
SOURCE: Peterse EFP et al. Health Affairs. 2017 Dec;36(12):2151-9.
Currently, Medicare covers colorectal screening at no charge to the patient, but if a polyp is removed upon discovery during the procedure, the patient would then be subject to Medicare’s coinsurance payments for both the colonoscopy and the removal.
Researchers used the Microsimulation Screening Analysis-Colon model to estimate the cost-effectiveness of waiving coinsurance for every component of colorectal cancer screening. They estimated that, currently, using the colonoscopy regimen with coinsurance, 12.8 colorectal cancer deaths occurred per 1,000 people aged 65 years and 124.1 QALYs were gained per 1,000 people aged 65 years. The total number of procedures per 1,000 Medicare beneficiaries was 1,132, of which 410 (36%) were potentially subject to coinsurance requirements.
“We estimated that the total lifetime costs for [the Centers for Medicare & Medicaid], which included colorectal cancer screening, surveillance, and treatment with coinsurance, to be $2.675 million per 1,000 sixty-five-year-olds,” Ms. Peterse and her colleagues wrote.
Researchers noted that if the coinsurance was waived but there was no follow-on increase in the screening rate, the benefits of screening would not change but the total cost of screening and treatment would increase to $2.726 million per 1,000 people aged 65 years.
However, “an assumed 5-percentage-point increase in the rates of first colonoscopy screening and surveillance decreased the number of colorectal cancer deaths by 0.9 (6.4 percent), accompanied by an increase of $33,000 (1.2 percent) in total costs, with a cost per QALY gained (or cost-effectiveness ratio) of $4,086.”
They added that estimated screening benefits were similar when fecal testing was the primary screening method.
“In general, [fecal testing] screening was associated with lower number of procedures subject to coinsurance,” the researchers added. “If [fecal testing] screening becomes more popular in the United States, following trends observed in several settings, the costs of waiving coinsurance would be even lower.” The researchers also suggest that it could lead to reducing disparities of colorectal cancer in the United States as well.
AGA has been working for years to try to fix this issue, and supports the bipartisan Removing Barriers to Screening Act, which would correct this inequity for Medicare beneficiaries and remove the financial barriers that may prevent a patient from undergoing a screening. AGA is hopeful that the growing support for the legislation on both sides of the aisle will help get the bill passed this year. To learn more about this issue, visit http://www.gastro.org/take-action/top-issues/patient-cost-sharing-for-screening-colonoscopy. To help your patient understand this issue, AGA has created “What to Expect: Paying for Your Colonoscopy,” which can be downloaded at http://www.gastro.org/patient-care/procedures/Colonoscopy_CoPay_WhatToKnowFactSheet.pdf to be shared in your office. /p>
gtwachtman@frontlinemedcom.com
SOURCE: Peterse EFP et al. Health Affairs. 2017 Dec;36(12):2151-9.
FROM HEALTH AFFAIRS