This morning, Inside Health Policy highlighted the ongoing concerns of senators from both parties over the Centers for Medicare and Medicaid Services (CMS) recent proposal on Part B drug payment. The two-part demonstration would adjust the physician reimbursement formula and use value-based pay arrangements in its second phase.
Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho commented as a part of the article, noting that patient groups “stand ready to work with CMS to develop alternative patient-centered approaches, but CMS’ failure to engage patients from day one has resulted in a deeply flawed proposal.” In a statement, Coelho was also quoted as saying, "CMS stirred up such controversy that they really have no choice but to start over and initiate a new more engaged process so patients are with them and not against them on this."
Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho commented as a part of the article, noting that patient groups “stand ready to work with CMS to develop alternative patient-centered approaches, but CMS’ failure to engage patients from day one has resulted in a deeply flawed proposal.” In a statement, Coelho was also quoted as saying, "CMS stirred up such controversy that they really have no choice but to start over and initiate a new more engaged process so patients are with them and not against them on this."
The article is available in full below.
Senators Raise Concerns With Part B Drug Pay Demo's Size, Effect On Rural Providers
Senators on both sides of the aisle questioned the size of CMS' proposed Part B drug pay demonstration Tuesday (June 28), while many lawmakers also raised concerns over how the demonstration could affect small-practice providers and those in rural areas. CMS Deputy Administrator and Chief Medical Officer Patrick Conway said the agency is looking to see if adjustments to the demonstration's size, the effects on rural providers and small practices, and patient access are necessary in the final rule in light of comments in those areas.
The agency proposed a two-part demonstration that begins by changing the physician reimbursement formula from 106 percent of drugs’ average sales price to 102.5 percent of the average, plus a flat $16.80 fee. The second phase involves value-based pay arrangements on which CMS asked for feedback, including use of: discounts or elimination of patient cost-sharing; prescribing patterns and online decision-support tools; reference pricing; and risk-sharing agreements based on outcomes; and indications-based pricing.
Senate Finance Chair Orrin Hatch (R-UT) called both phases of the demonstration “very troubling -- and that's putting it kindly.” Sen. Richard Burr (R-NC) asked Conway twice if the agency is considering withdrawing the proposed rule, and Conway responded both times that the agency intends to take comments into account for the final rule.
Hatch said that with the backlash the program has created, if CMS moves forward with the demonstration, it will do so over the concerns and objections of many experts and stakeholders.
Tony Coelho, chair of the Partnership to Improve Patient Care, said that patient groups “stand ready to work with CMS to develop alternative patient-centered approaches, but CMS’ failure to engage patients from day one has resulted in a deeply flawed proposal.”
“CMS stirred up such controversy that they really have no choice but to start over and initiate a new more engaged process so patients are with them and not against them on this,” Coelho said in a statement.
Sens. Rob Portman (R-OH), Debbie Stabenow (D-MI) and Tom Carper (D-DE) all questioned the size and scope of the demonstration. Portman called CMS' proposal hardly a demonstration, and more of a wholesale change since it affects about 75 percent of Part B medications.
Conway said the agency was reviewing the comments CMS received in May, and CMS plans to make adjustments in to the final rule. One of those areas is the size of the demonstration.
AARP, AFL-CIO, Center for American Progress, Medicare Rights Center and others that support the demonstration sent a letter to the lawmakers Monday (June 27) laying out improvements the groups think should be made to the demonstration, including a recommendation to address concerns about the size and scope of the demonstration, like those raised by the lawmakers.
“CMS should move forward with a payment model that allows the agency to generalize results, compare payment strategies, and scale promising outcomes,” the groups said. “At the same time, CMS should be responsive to concerns raised about how independent and rural physician practices will fare under the proposal.”
They suggested that CMS could limit the demonstration by allowing for a provider exceptions process that requires providers to submit information on Part B drug acquisition costs. That process could give special consideration to small practices in underserved and rural areas, the groups said.
Ranking Democrat Ron Wyden (OR), Sen. Charles Grassley (R-IA) and other lawmakers raised concerns over what could happen to providers and beneficiaries in rural areas. Wyden worries those beneficiaries could end up going to costlier hospitals for treatment.
Hatch noted in his opening statement that CMS has not provided an analysis of how many physicians, including those in small and rural practices, would lose money, or how CMS plans to assess the impact on beneficiary access and quality -- though Conway said CMS plans to run a real-time monitoring program to track beneficiary access.
Conway said CMS proposed to include rural providers and small practices in the demonstration, but knew there could be concerns. CMS will look closely at public comments to see if changes for rural and small practice providers are needed in the final rule, he said.
