ASCO recently hosted a webinar outlining important changes to Medicare reimbursement starting Jan. 1, 2019. The event, 2019 Medicare Reimbursement – Final Rules Update, provided details on how provisions in the Hospital Outpatient Prospective Payment System (HOPPS), as well as the Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) final rules will impact cancer care in the year ahead.
The Centers for Medicare & Medicaid Services (CMS) estimates that the overall impact of the fee schedule and QPP rule will be a one percent reimbursement cut for the hematology/oncology and radiation/oncology specialties in 2019, though the actual impact on individual physician practices will depend on the mix of services the practice provides.
The webinar highlights some noteworthy changes in the fee schedule and QPP rule, including:
- CMS is finalizing a proposal to reduce the documentation burden for Evaluation & Management (E&M) services.
- CMS is finalizing a proposal to reimburse new Medicare Part B drugs—and drugs that do not have a reported Average Sales Price (ASP)—at Wholesale Acquisition Cost (WAC) plus three percent.
- CMS is finalizing provisions to consolidate E&M payments. The agency did listen to feedback from ASCO and other stakeholders by revising its proposal, which—if fully implemented—will not impact providers until 2021.
- Under QPP, the 2019 payment adjustment for MIPS practices and providers will be plus or minus seven percent with adjustments for budget neutrality and exceptional performance.
- Under QPP, the Merit-Based Incentive Payment System (MIPS) performance threshold will be increased from 15 points in 2018 to 30 points in 2019.
Additionally, the webinar covers changes to the HOPPS rule, which finalized cuts to Medicare reimbursement for certain visits to hospital outpatient clinics and extended 2018 cuts to the 340B Drug Pricing Program. Specifically:
- CMS will reimburse certain visits to hospital-affiliated off-campus providers at the lower MPFS reimbursement rate at which non-hospital affiliated providers are paid.
- The 2018 cut to 340B—which took reimbursement for eligible Medicare Part B drugs from Average Sales Price (ASP) plus six percent to ASP minus 22.5 percent—will be applied to previously exempt off-campus, provider-based hospital-affiliated clinics.
ASCO members can watch this webinar online to get prepared for 2019.
Keep an eye on ASCO in Acton for Medicare reimbursement updates and breaking cancer policy news.