ASCO: Proposed Medicare Payment Changes Could Hurt Quality Cancer Care

A new rule in the Medicare Access and CHIP Reauthorization Act’s 2019 Quality Payment Program (QPP) and the proposed 2019 Medicare Physician Fee Schedule (MPFS) could negatively affect the quality of cancer care for Medicare beneficiaries, according to the American Society of Clinical Oncology (ASCO).

In order to address its concerns, ASCO sent a letter to the US House of Representatives Energy and Commerce Committee. In it, ASCO President Monica M. Bertagnolli, MD, FACS, FASCO, explained how the changes could limit the ability of high-performing providers to receive bonuses.

Bertagnolli wrote that the changes raise “several questions about how oncology practices will be able to continue to provide the highest quality care for Medicare beneficiaries.”

The proposed QPP rule increases the weight for the cost category under the Merit-based Incentive Payment System (MIPS) from 10% to 15% without an updated methodology. ASCO is calling for a risk adjustment that accounts for the severity and variation of high-cost therapies when treating patients with cancer, Bertagnolli explained.

The MPFS is proposing a 4% cut in reimbursement for oncology services, a decrease in reimbursement for new Part B drugs, and an overhaul of evaluation and management coding that “does not reflect accurately services and resources practices deliver to complex patients,” she wrote.

Bertagnolli goes on to explain that the reimbursement cut could mean oncology practices reduce some of the unpaid or underpaid services they provide to patients with cancer.

“ASCO opposes the cuts in the proposed MPFS and believes they will harm Medicare beneficiaries with cancer, impede MIPS implementation, and risk access to appropriate anti-cancer therapies,” Bertagnolli wrote.

The end result of these proposals would be that the best performers would only receive a 2% bonus, rather than the 4% bonus authorized by law. Even if they met all necessary quality improvement and value requirements, providers and practices would see a decrease in their overall reimbursement for 2019.

The comment period on the proposed QPP ends September 30, 2018. The comment period on the MPFS ends September 10, 2018.