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.
ASCO in Action regularly provides the latest news and analysis related to cancer policy news; see the following online articles. These updates provide snapshots of ASCO’s ongoing advocacy efforts, as well as opportunities for ASCO members and guests to take action on critical issues affecting the cancer community.
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On December 5 from 4:00-5:00 PM ET, ASCO will host the latest installment in its webinar series on the 2019 Medicare Physician Fee Schedule (MPFS). This webinar, 2019 Medicare Reimbursement – Final Rules Update, comes as the Centers for Medicare & Medicaid Services (CMS) recently released its final rule outlining reimbursement changes to the MPFS, Quality Payment Program (QPP) and Hospital Outpatient Prospective Payment System (HOPPS) for 2019.
Update: ASCO’s resolutions on step therapy, Medicare Part B drugs, a Competitive Acquisition Program (CAP), and clinical trial access were adopted or reaffirmed by the American Medical Association (AMA) House of Delegates, as well as an ASCO-backed resolution on Qualified Clinical Data Registries (QCDRs).
Leaders from the ASCO State Affiliate Council met to discuss pressing issues in oncology, including drug pricing, Medicaid work requirements, changes to the Medicare physician fee schedule, and the role of pharmacy benefit managers (PBMs).
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.
The Centers for Medicare & Medicaid Services (CMS) released its 2019 Hospital Outpatient Prospective Payment System (HOPPS) final rule. An initial evaluation of the rule found that CMS finalized provisions cutting Medicare reimbursement for certain visits to hospital outpatient clinics and to extend 2018 cuts to the 340B Drug Pricing Program.
On October 25, 2018, CMS released the International Pricing Index Model for Medicare Part B Drugs, an advanced notice of a proposed rule that, if implemented, would establish a pilot program to test ways to lower the costs of drugs. Provisions in the proposal include benchmarking some part B drug prices against other countries and changing how providers get paid for administering drugs to patients. The proposal marks the most sweeping changes the Administration has put forth to implement the President Trump’s “blueprint to lower drug prices and reduce out-of-pocket costs.”
The Center for Medicare & Medicaid Services (CMS) has released performance feedback for Merit-based Incentive Payment System (MIPS) clinicians who participated the 2017 performance year. Individual clinicians, groups, and eligible clinicians in certain Alternative Payment Models (APMs) can access a comprehensive overview of their MIPS final score, performance category details, and 2019 MIPS payment adjustment on the Quality Payment Program (QPP) website.
In a comment letter to the Centers for Medicare & Medicaid Services (CMS) ASCO expressed significant concerns that provisions in the 2019 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule would undermine Medicare beneficiary access to cancer care due to reimbursement cuts based on site-of-service that fail to address systemic payment deficiencies for cancer care services under Medicare. ASCO urges CMS to forego implementing any additional utilization management strategies and instead enhance patient access to cancer care by facilitating participation in Advanced Alternative Payment Models (APMs) that use oncology clinical pathways to promote high-quality cancer care.
ASCO recently hosted a webinar offering an overview of the 2019 Medicare Physician Fee Schedule and Quality Payment Program proposed rule and its potential impact on individuals with cancer. ASCO strongly opposes aspects of the proposed rule that could significantly cut cancer care resources needed to provide high-quality care, and the society urges the Centers for Medicare & Medicaid Services (CMS) to abandon the proposal. ASCO members can still watch this important webinar and view the slides from the presentation.
ASCO leaders recently met with representatives from the Trump Administration to discuss the delivery of high-quality, high-value cancer care as the Administration implements its “blueprint to lower drug prices and reduce out-of-pocket costs.”
In the latest ASCO in Action Podcast, ASCO CEO Dr. Clifford A. Hudis discusses the recently released Medicare Physician Fee Schedule (MPFS) proposed rule. The MPFS is a complete listing of all fees Medicare uses to reimburse doctors and other providers and suppliers under a fee-for-service payment system.
Representatives from ASCO and other medical specialty groups recently met with officials from the U.S. Department of Health and Human Services (HHS) to discuss the 2019 Medicare Physician Fee Schedule (MPFS). The meeting provided Administration officials with an opportunity to explain provisions in the 2019 MPFS proposed rule and for stakeholders to ask questions and express their concerns with the proposal.
ASCO submitted a statement to the U.S. House of Representatives Energy and Commerce Committee in conjunction with a subcommittee hearing on implementation of the Merit-Based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act (MACRA).
On July 25, the Centers for Medicare & Medicaid Services released its 2019 Hospital Outpatient Prospective Payment System proposed rule. Among other provisions, the proposal would extend 2018 reimbursement cuts to the 340B Drug Pricing Program to include currently excepted, off-site hospital-affiliated outpatient clinics.