Public Payers News

Do Medicare Part B Prescription Drug Changes Hurt Rural Hospitals?

Before following through with finalizing the changes to the Medicare Part B drug prescription program, CMS would benefit from addressing the many concerns sent forward during the comment period.

By Vera Gruessner

The proposed changes to the Medicare Part B prescription drug program is finding opposition among multiple medical organizations. The Centers for Medicare & Medicaid Services (CMS) will need to address the problems in the new proposed rule before continuing with finalizing these changes. The American Medical Group Association (AMGA) sent a letter to CMS stating its concerns with the renovations of the Medicare Part B prescription drug program.

Value-Based Care Reimbursement

According to a press release from AMGA, CMS should consider testing other options of the average sales price add-on payment as well as ensure that Medicare beneficiaries have full access to clinical decision data.

Additionally, physicians and other clinicians will need access to updated drug safety information as well as best practices guidelines. The AMGA also seeks for CMS to provide more details on exactly how hospitals and doctors will be evaluated on quality performance benchmarks.

The association is also stating that its members are looking to improve the quality and effectiveness of drug prescribing practices that benefit Medicare beneficiaries. These concerns will need to be addressed by CMS before any changes to the Medicare Part B prescription drug program are implemented by the agency.

Two months ago, CMS released the proposed rule that would affect reimbursement of providers operating through the Medicare Part B prescription drug program. New payment models would be used to help clinicians prescribe the right medication for their patients covered under Medicare. Positive Health outcomes would be tied into the reimbursement of providers once a medication is prescribed and utilized. CMS is also looking to reduce the spending associated with Medicare Part B since the costs of certain drugs have been rising in recent years, as the graph below illustrates.

Donald W. Fisher, Ph.D. President and CEO of AMGA, wrote in the letter sent to CMS regarding its proposed rule for the Medicare Part D prescription drug program that its association’s members are interested in learning which tools could benefit value-based care reimbursement when it comes to drug prescribing practices.

“Using value-based purchasing tools to reduce overall drug spending and improve clinical effectiveness is a worthy goal, and efforts to that end can only serve to also improve Medicare beneficiary health,” Fisher said in a public statement. “However, the concerns expressed in our comment letter also must be addressed in order to ensure that the demonstration is as successful as possible for Medicare beneficiaries and providers alike.”

Additionally, Fisher mentions the importance of evaluating behavioral responses with regard to payment changes and any pricing alternatives tied to value-based care payment models. AMGA is also considering whether these drug prescription payment reforms will negatively affect small and rural providers including hospitals. To avoid these problems, it is important for CMS to survey hospitals, suppliers, and beneficiaries when any changes have been implemented, the letter states.

“CMS recognizes, or is concerned, the demonstration may have unintended negative effects on small and/or rural providers including rural hospitals,” the letter stated. “Since it is impossible to know with certainty the effect the alternative payment will have on these providers the evaluation can be designed to produce quarterly, semi-annual or annual data that compares prescribing patterns or utilization for these providers to their historic patterns. CMS also notes the agency is considering surveying providers, beneficiaries, and suppliers. Surveying these subsets of demonstration participants, for example after the first year of the demonstration, could prove useful.”

The Community Oncology Alliance (COA) has also found various problems with the proposed rule renovating the Medicare Part B prescription drug program. The organization has stated that this proposed rule is “bad medicine, flawed economics, and destructive policy.”

The COA is looking to put an end to this proposed rule even if it means taking legal action to do so. The organization is claiming that the changes CMS is proposing will hurt clinical decision-making since it is not based on the procedures necessary for prescribing medication in the oncological care setting.

In particular, the Community Oncology Alliance fears that this proposed rule will push oncologists to prescribe less expensive drugs that do not have the same positive health outcomes as more costly medication. If this occurs, Medicare beneficiaries with a cancer diagnosis could suffer needlessly.

There are very few instances where substituting an inexpensive medication in cancer care would actually be safe for the patient, COA stated. In addition, reducing costs for Medicare Part B has only led to more expensive, inpatient hospital care in the past.

Before following through with finalizing the changes to the Medicare Part B drug prescription program, CMS would benefit from addressing the many concerns sent forward during the comment period. It may also be more beneficial for CMS to work with the pharmaceutical industry to reduce the costs of drugs instead of pushing these type of regulations on hospitals and providers around the country.

Image Credits: Centers for Medicare & Medicaid Services (CMS)

 

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