Medicare Monday: What they’re saying about the CMS proposed Part B payment model

Voices throughout the media and health care system have raised concerns with the Part B Drug Payment Model proposed by CMS.

Nicole LongoMay 9, 2016

Medicare Monday: What they’re saying about the CMS proposed Part B payment model.

MedMon_Catalyst_Banner.jpgVoices throughout the media and health care system have raised concerns with the Part B Drug Payment Model proposed by the Centers for Medicare & Medicaid Services (CMS). News outlets have called attention to the lack of needed safeguards to protect patients from access barriers and reduced quality of care. Here are some recent highlights:

  • “While CMS’ intent is to save money, the results of this demonstration stand to severely impact patients who rely on Medicare. The reduction in reimbursement will force many providers to stop offering the most clinically effective treatments, leaving patients with two options: forego prescribed therapies or travel to more expensive settings to receive treatment and absorb the associated increased costs,” writes Marcia Boyle, president and founder of the Immune Deficiency Foundation, in an op-ed in The Hill.

  • “The government has not ‘accounted for behavioral and treatment changes that could occur,’ wrote Adam Fein of Pembroke Consulting, who tracks drug distribution, on his blog. ‘These marketplace realities will undermine the … ability to draw accurate conclusions’ from the experiment,” reports STAT.

  • “The American Society of Clinical Oncology lashed out at the Innovation Center's intent to ‘modify drug reimbursement based on Zip codes,’ calling it ‘inappropriate for CMS to manipulate choice of treatment for cancer patients using heavy-handed reimbursement techniques,’” reports Modern Healthcare.

  • “Instead of taking the views of patients and people with disabilities seriously, the Centers for Medicare and Medicaid Services (CMS) recently proposed to set national policy based on assessments such as those generated by the Institute for Clinical and Economic Review (ICER). […] Reliance on average value assessments is not a policy that drives ‘value for the patient,’ as CMS indicates in the proposed rule - it is a policy intended to contain short-term costs by limiting choices for patients. Yet, the result is a less effective and efficient system of care,” explains Tony Coelho, Former House Majority Whip, in a Huffington Post op-ed.

  • “ASCO reported that it has data showing ‘that since the demo would reduce the reimbursement for Part B drugs from 104.3% of ASP to 100.86% of ASP with a flat fee add-on payment of $16.53 per drug per day, the number of so-called ‘underwater drugs’ would increase.’ They noted that ‘in some practices, more than 50% of drugs would be underwater.’

  • “ASCO considers the demonstration project to be ‘based on the false premise that patients typically have multiple treatment options and doctors choose the most expensive treatment.’ They stress that ‘in fact, patients often only have one suitable treatment option, so oncologists have limited opportunity to reduce drug utilization costs by selecting lower cost alternatives.’ […] The proposal ‘really is an experiment on patients,’ said Shelagh Foster, JD, the senior director of advocacy for ASCO, at the COA panel discussion. ‘They have no mechanism to measure outcomes, and this is really concerning,’” reports Clinical Oncology News.

  • “The proposed rule currently lacks much detail, and there does not seem to be enough time for organizations to evaluate the impact of the proposed rule on their operations,” writes Kavita Patel and Caitlin Brandt of the Brookings Institute in Health Affairs.

  • “CMS’ controversial proposed demonstration aimed at bringing down Part B drug costs is unlikely to count as an alternative pay model in the agency's revamp of the physician-pay system, health policy experts say. Also, rheumatologists argue that factoring in the Part B demonstration would distort physician comparisons in the Merit-Based Incentive Payment System, which will also be part of the new physician-pay scheme,” reports Inside Health Policy.

tn_MedMon.jpgLearn more about the Medicare Part B program at

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