2019 Physician Fee Schedule and Quality Payment Program Final Rule Released

November 2, 2018

The Centers for Medicare & Medicaid Services (CMS) released the final rule for the Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) outlining reimbursement changes for  2019. CMS estimates that the overall impact will be a one percent reimbursement cut for the hematology/oncology and radiation/oncology specialties in 2019. Based on feedback from ASCO, significant changes were made, which helped to avoid an overall four percent reduction for the specialty. However, it is important to note that the actual impact on individual physician practices will depend on the mix of services the practice provides.

For calendar year 2019, CMS finalized provisions from its proposed rule to reduce the documentation burden for Evaluation & Management (E&M) services and to reimburse new Medicare Part B drugs—and drugs that do not have a reported Average Sales Price (ASP)—at Wholesale Acquisition Cost (WAC) +3 percent. New Part B drugs are currently reimbursed at WAC +6 percent.

While CMS also finalized provisions to consolidate E&M payments, the agency did listen to feedback from ASCO and other stakeholders in the physician community by revising its proposal, which—if fully implemented—will not impact providers until 2021. At that time, CMS will consolidate levels 2-4 and continue to pay for level 5 E&M services separately. New guidance on the use of add-on codes and the Multiple Procedure Payment Reduction have also been delayed until at least 2021. In the meantime, ASCO will work with CMS to arrive at the most appropriate policies before any E&M changes go into effect.  

Proposed changes to the Quality Payment Program (QPP) for 2019 include increasing the Merit-Based Incentive Payment System (MIPS) performance threshold from 15 points in 2018 to 30 points in 2019. The MIPS “exceptional performance threshold,” however, was lowered from 80 points in the proposed rule for 2019 to 75 points in the final rule. The final 2019 payment adjustment for MIPS practices and providers will be plus or minus 7 percent with adjustments for budget neutrality and exceptional performance.

CMS also finalized two new optional opioid measures in the MIPS Promoting Interoperability (formerly Advancing Care Information) category: (1) checking the Prescription Drug Monitoring Program (PDMP) and (2) verifying a treatment agreement. There are also eight new episode-based measures in the MIPS cost category, none of which are cancer-related.

ASCO is analyzing the final rule and assessing its full impact on the oncology community. The society will submit feedback on the rule to CMS during the open comment period.

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