• Academy Seeks Answers to Troubling Part B Drug Proposal


    The Academy is questioning a new addition to Medicare’s physician payment system that could limit patients’ access to treatments involving Part B drugs. If the Centers for Medicare & Medicaid Services impose quality-program penalties and bonuses to Part B drug payments, it could compel some ophthalmologists to limit the Part B drug-related services they offer. 

    Under the Merit-Based Incentive Payment System, CMS adjusts clinicians’ Medicare pay depending on performance. For MIPS clinicians who bill for Part B drugs, CMS is proposing that it apply the payment adjustments to these reimbursements. The Academy believes a reduction in drug reimbursements could compel physicians to cease procedures that are especially risky. 

    We believe Congress did not intend for this change when it passed the law that resulted in the Quality Payment Program. A technical correction may be needed to shield drug-related payments from penalties or bonuses. 

    The proposed policy would be a remarkable shift for Medicare and CMS. 

    For example, after applying several mandated adjustments, a low-performing physician who receives a 2019 penalty could see drug payments effectively cut to Average Sales Price+1 percent. A high-performing physician, on the other hand, could see drug payments increased up to ASP+7.6 percent. Very high performers will also be eligible for additional bonus payments. 

    Such a broad application of penalties and bonuses could compel physicians to adopt risk-averse care. This would then force patients to travel to larger practices to receive the care they require. They might also forgo treatment.