As previously reported, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining a demonstration project that would reduce the Average Sales Price (ASP) reimbursement rate based on primary care service areas based on zip codes, sparking widespread concerns over its singular focus on drug costs, costs that oncologists do not—and cannot—control. ASCO has responded assertively in opposition of the mandatory five-year Part B Drug Payment proposal, and will maintain pressure on CMS to withdraw the proposal and focus on real reform that cuts costs and enhances care, while protecting the health and safety of Medicare patients who rely on Medicare Part B drugs.
ASCO joined hundreds of stakeholder groups in signing three separate letters asking the U.S. Department of Health & Human Services, CMS, and Congress to withdraw the ill-advised proposal. The society also urges its members to take action by contacting their elected officials through ASCO's ACT Network (to date, ASCO members have sent more than 1,000 messages to Capitol Hill opposing the Part B demo).
In ASCO’s view, the demonstration project is based on the false premise that patients typically have multiple treatment options and doctors choose the most expensive treatment. In fact, patients often only have one suitable treatment option, whereby oncologists cannot reduce drug utilization costs by selecting lower cost alternatives. ASCO's preliminary analysis of the reduced reimbursement rate suggests practices will, on average, lose $30,000-$35,000 per physician FTE (the exact amount will vary depending on patient mix, geography, setting, and other variables).
The Society is expanding its analyses of the Medicare Part B demonstration project and has developed an ASP Practice Modeling Tool for individual oncology practices to determine the real-life impact of the five-year Medicare Part B demonstration project. Practices are guided through a four-step process to review the Medicare portion of their businesses using data from the fourth quarter of 2015 under several different ASP scenarios. Participating practices are asked to share results with ASCO, which will aggregate the data to assess the impact of the Medicare proposal on practices across the United States and to inform future advocacy efforts on this critically important issue. (Practice names will be kept confidential),
Detailed instructions are available in the first tab of the ASP Practice Modeling Tool. For additional questions about the tool and to share results with ASCO, please email Elaine L. Towle, ASCO’s Director of Analysis and Consulting Services. Modeling results must be submitted no later than Friday, April 15, 2016.
Aside from these efforts, ASCO has been a prominent voice in media coverage of the CMS proposal and its opposition was highlighted in articles in MedPage Today, Modern Healthcare, The New York Times, Politico, The Wall Street Journal, and other news organizations. The society also submitted letters to the editor of The New York Times and The Washington Post in response to op-eds supporting the model.
Keep an eye on ASCO in Action, for updates on the latest advocacy efforts in opposition of the Medicare Part B Drug Payment demonstration project.