Medicare Compliance & Reimbursement
CMS Creates Proposal for New Medication Injection Payments
In its ongoing effort to pay physicians based on quality of care and to cut costs, CMS has released a proposal to overhaul the way physicians are paid to administer drugs. The agency has offered six proposed approaches to pay for Part B drugs, including one that would reimburse doctors for the average sales price of a drug, plus a 2.5 percent add-on, as well as a flat fee payment of $16.80 per drug per day. Meanwhile, a “control group” would continue to be paid the current way, which is to collect the drug’s average sales price plus a 6 percent add-on.
CMS would then compare the control group to the study group to determine whether the study group saw reduced Medicare spending and improved patient care. “These models would test how to improve Medicare beneficiaries’ care by aligning incentives to reward value and the most successful patient outcomes,” said CMS’s Dr. Patrick Conway in a March 8 statement. “The choice of medications for beneficiaries should be driven by the best available evidence, the unique needs of the patient, and what best promotes high quality care.”
The proposal came on the heels of a strongly-worded March 4 letter from over 100 physician advocacy groups to CMS and HHS, urging the agencies to halt the drug proposal. The groups cited CMS’ recent rush-through of the Medicare hip and knee replacement model as the wrong way to create proposals, and urged the agencies not to make the same mistakes with drug payments.
“We strongly oppose any effort to rush through a similar initiative that may adversely impact patients’ access to life-saving and life-changing Medicare Part B covered drugs,” said the letter, which was signed by groups including the American College of Rheumatology, CancerCare, RetireSafe, and many other organizations.
Resource: To read more about the proposal, visit www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-08.html.
Medicare Compliance & Reimbursement
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CMS Creates Proposal for New Medication Injection Payments
In its ongoing effort to pay physicians based on quality of care and to cut [...]
