12/04/2017

Ask Congress to act now to address the MIPS Adjustment to Part B Drugs!

Congress must act to address the MIPS Adjustment to Part B Drugs:  
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BACKGROUND:

• Under MACRA, most physicians will initially fall under the Merit-based Incentive Payment System (MIPS) program for the Medicare payments they receive for physician services.
• Based on aggregate scores that physicians receive each year under MIPS they may receive either a bonus or a penalty in their reimbursement. The range of these bonuses or penalties is intended to be +/- 4%.
• Due to the way legislative language is written, the Center for Medicare and Medicaid Services (CMS) will be applying the MIPS payment adjustment to Part B drugs (those administered in office) in addition to physician services. 
• This is a departure from CMS' previous policy for applying payment adjustments only to physician services for the historic quality programs, upon which MIPS is based.
• Applying the MIPS adjustment to Part B drugs distorts the intent of the MIPS adjustment and unfairly amplifies the bonus or penalty in specialties that administer high-cost drugs bringing their range to +/- 13-22% for oncology.
• Congressional intervention is necessary to address the improper application of the adjustment.

CURRENT STATUS:

• In October, bipartisan efforts in the House and the Senate sent letters to the Department of Health and Human Services urging the exclusion of separately payable Part B drugs from the application of the MIPS adjustment in order to better achieve the overarching goals of MACRA and to apply the MIPS adjustments in a fair and consistent manner.
• The final rule released this month by the Centers for Medicare and Medicaid Services did not address the concerns of these letters.
• Recently ASCO and several other specialty societies sent a joint letter to Chairmen Hatch, Walden and Brady and Ranking Members Wyden, Pallone and Neal asking for their legislative help on this issue.

ALERT CONGRESS TODAY:

• Ask your lawmaker to intervene this year with a technical correction to ensure the Merit-based Incentive Payment (MIPS) score adjustment is not applied to Part B drug payments.

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