On July 13, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for 2018 Medicare physician reimbursement. CMS estimates that in calendar year 2018 reimbursement for the hematology/oncology specialty is set to remain the same, though the actual impact on individual physician practices will depend on the mix of services provided.
The rule, "Medicare Program: Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program," will be published in the Federal Register on July 21. The prepublication version is available online.
Separately, on July 13, CMS released the "Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs" online, which will be published in the Federal Register on July 20. This proposal would cut reimbursement for hospital drugs acquired at a 340B discount rate from the current rate of ASP+6 percent to ASP-22.5 percent.
The Hospital Outpatient Prospective Payment System (HOPPS) proposed rule also shows that CMS is considering a modification to the policy governing the of billing molecular pathology tests and advanced diagnostic laboratory tests that are excluded from the HOPPS packaging policy and ordered less than 14 days after the patient's discharge from the hospital. Referred to as "the 14-day rule," the proposed modification would allow laboratories to bill Medicare directly for these tests, rather than the current requirement that hospitals must bill Medicare for such tests, and then reimburse the laboratory.
ASCO is currently assessing the potential impact of both proposals on the oncology community and will offer additional details when they become available. The society will also submit comments on both proposed rules before the open comment period closes on Sept. 11, 2017. Watch ASCO in Action for updates.