A new rule in the Medicare Access and CHIP Reauthorization Act’s 2019 Quality Payment Program and the proposed 2019 Medicare Physician Fee Schedule could negatively affect the quality of cancer care for Medicare beneficiaries, according to the American Society of Clinical Oncology.
A new rule in the Medicare Access and CHIP Reauthorization Act’s 2019 Quality Payment Program (QPP) and the proposed 2019 Medicare Physician Fee Schedule (MPFS) could negatively affect the quality of cancer care for Medicare beneficiaries, according to the American Society of Clinical Oncology (ASCO).
In order to address its concerns, ASCO sent a letter to the US House of Representatives Energy and Commerce Committee. In it, ASCO President Monica M. Bertagnolli, MD, FACS, FASCO, explained how the changes could limit the ability of high-performing providers to receive bonuses.
Bertagnolli wrote that the changes raise “several questions about how oncology practices will be able to continue to provide the highest quality care for Medicare beneficiaries.”
The proposed QPP rule increases the weight for the cost category under the Merit-based Incentive Payment System (MIPS) from 10% to 15% without an updated methodology. ASCO is calling for a risk adjustment that accounts for the severity and variation of high-cost therapies when treating patients with cancer, Bertagnolli explained.
The MPFS is proposing a 4% cut in reimbursement for oncology services, a decrease in reimbursement for new Part B drugs, and an overhaul of evaluation and management coding that “does not reflect accurately services and resources practices deliver to complex patients,” she wrote.
Bertagnolli goes on to explain that the reimbursement cut could mean oncology practices reduce some of the unpaid or underpaid services they provide to patients with cancer.
“ASCO opposes the cuts in the proposed MPFS and believes they will harm Medicare beneficiaries with cancer, impede MIPS implementation, and risk access to appropriate anti-cancer therapies,” Bertagnolli wrote.
The end result of these proposals would be that the best performers would only receive a 2% bonus, rather than the 4% bonus authorized by law. Even if they met all necessary quality improvement and value requirements, providers and practices would see a decrease in their overall reimbursement for 2019.
The comment period on the proposed QPP ends September 30, 2018. The comment period on the MPFS ends September 10, 2018.
CMS' 340B Repayment Proposal May Harm Vulnerable Hospitals, Reward Those With Higher Revenues
April 26th 2024The 340B hospitals not receiving an offsetting lump-sum payment from CMS following 2018-2022 cuts later ruled unlawful are disproportionately rural, publicly owned, and nonacademic, according to a new study.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
The Federal Trade Commission's (FTC's) vote to ban most employers from issuing and enforcing noncompete clauses could have varying impacts on the health care workforce; federal regulators vastly under-enforced antitrust laws in the hospital sector during the last 2 decades, resulting in increased health costs; the FDA recently found genetic evidence of the H5N1 bird flu virus in pasteurized commercially purchased milk.
Read More