ASCO Responds to CMS on Reimbursement Changes Under MACRA

When President Obama signed legislation authorizing the Medicare Access and CHIP Reauthorization Act or MACRA to replace the much-despised sustainable growth rate formula, commonly known as SGR, on April 16, 2015, a big sigh of relief could be heard from providers. Praising the lawmakers who worked toward avoiding the 21% reimbursement cut under SGR—since the formula was linked to the gross domestic product—Obama said, “This bill is consistent with that proposal — it’s a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs.”

In response to CMS’ request for information, the American Society of Clinical Oncology (ASCO) has made public its detailed guidance to the federal body, supporting implementation of physician-focused and other alternative payment models (APMs) under MACRA.

In a press release summarizing the guiding principles developed by ASCO, the organization’s President Julie Vose, MD, MBA, FASCO, said, “As CMS works to transform the Medicare physician reimbursement system, we provided—and will continue to provide—the agency with robust feedback based on what we've learned over many years from ASCO's payment reform efforts.”

The following are the 11 guiding principles provided by ASCO to CMS that would ensure a sustainable Medicare payment system in clinical oncology:

• Ensuring that there are multiple APMs focused on clinical oncology to permit oncologists to select a model that is patient-centered and that meets the challenges facing their patients, practice, and community.
• Creating multiple mechanisms to facilitate transitions for physicians who initially participate in MIPS to subsequently move to an APM in future years.
• Improving quality reporting and minimizing disparities in access to high-quality, high-value oncology care by promoting meaningful quality measures and promoting quality improvement in cancer care through the use of qualified clinical data registries.
• Facilitating group reporting of quality data in APMs and Merit-Based Incentive Payment System (MIPS), since it is essential to improving clinical cancer care.
• Partnering with ASCO to create a risk adjustment methodology that is specific to cancer treatment to ensure that financial incentives do not exacerbate disparities in patient access to high-quality, high-value cancer care and hold oncologists accountable under resource use measurements primarily for expenditures that are under their direct control.
• Ensuring that oncologists are not penalized on the basis of resource consumption for providing high-quality, high-value cancer care.
• Permitting oncologists to select concordance with nationally recognized evidence-based, value-based clinical pathways in lieu of tracking resource use due to drug utilization under Medicare Part B or Part D.
• Promoting the use of existing audit tools for oncology under both MIPS and APMs to facilitate meaningful improvements in quality and value in cancer care.
• Taking active steps to ensure that the implementation of MIPS and APMs does not hinder access to clinical trials.
• Working with the Office of the National Coordinator for Health IT and Congress to ensure that achieving interoperability and preventing information blocking are national priorities.
• Avoiding the creation of additional administrative burdens and unfunded mandates that could undermine the ability of oncology practices to provide high-quality cancer care.

Vose is the keynote speaker at The American Journal of Managed Care’s Patient-Centered Oncology Care 2015 meeting in Baltimore, being held November 19-20, 2015.