Academy Gains New Allies Across Medicine to Oppose Penalties on Part B Drug Physician Payments

New allies this week backed up their support for one of the Academy’s biggest legislative priorities with a letter to Congress’ leaders with Medicare oversight. The Academy, along with the American Medical Association and more than 100 national and state specialty medical organizations, this week asked lawmakers to shield Medicare Part B drug payments to physicians from penalties. 

The request is part of an effort to adjust the Medicare Access and CHIP Reauthorization Act. This would help immediately fix the Quality Payment Program, the creation of which MACRA directed. The campaign’s goal is to provide federal regulators with broad, continued flexibility in the program’s formative years. 

Wide support for shielding Part B drug payments from penalties is a significant development. Under the Merit-Based Incentive Payment System, the Centers for Medicare & Medicaid Services adjusts clinicians’ Medicare pay based on performance. For MIPS clinicians who bill for Part B drugs, CMS proposes to also apply the performance payment adjustments to drug reimbursements. 

The Academy believes CMS is simply misinterpreting what Congress intended. Still, it could compel physicians to cease especially risky procedures. 

The request is part of a letter sent to leaders of three congressional committees: Energy and Commerce and Ways and Means in the U.S. House of Representatives, and the Senate Committee on Finance. These are the bodies with direct Medicare-program oversight. 

It urges Congress to clarify what it intended when it passed MACRA. We believe the law was supposed to provide significant flexibility under the program. 

In addition to drug payment shielding, the letter requests that Congress make other modifications to MACRA. This includes an additional three years of flexibility in the statute to allow for CMS to:

• Re-weight the resource use (cost) component. The law currently sets this weight at an untenable 30 percent.
• Select a performance threshold for success or failure that is appropriate. CMS could then gradually increase the performance threshold as physicians gain experience. 

The letter also asks Congress to ensure that the program’s definition for “small practice” reflects only MIPS-eligible professionals when meeting the threshold of 15 or fewer eligible professionals.