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    Change to Part B pay draws specialty ire

    AUA, other groups also urge additional work on MIPS cost score category

     

    The letter also urges congressional leaders to address the weighing of the cost score category of MIPS.

    Read: Tax law may threaten Medicare, provider pay

    "CMS has not outlined sound methodologies for risk adjustment for physicians with patient populations at risk for high resource use, and cost measures necessary under MIPS are still under development. Work remains to ensure that the new measures are developed and integrated in a way that accurately reflects the complexities of cost measurement and does not inadvertently discourage clinicians from caring for high-risk and medically complex patients. We believe that these methodologies and measures must be developed and validated before CMS moves forward with implementing this category," the letter states.

    “Taken together, these two issues could create a perfect storm for specialties whose patients depend on physician-administered drugs,” the groups concluded.

    According to Quardricos Driskell, MPS, MTS, government relations manager at AUA, the groups plan to meet with members of the Senate Finance and House Ways and Means committees to press the case.

    “On Jan. 1, 2017, MACRA transitioned to MIPS, a new way to pay physicians for care, which will make Medicare Part B physician payment adjustments based on a composite performance score,” John Feore, JD, and Richard Kane, MIPP, of Avalere Health, noted in a press release.

    MIPS is one of two pathways for clinician participation under MACRA. The other option, the Advanced Alternative Payment Model (AAPM), offers qualifying participants an annual 5% lump-sum bonus in payment years 2019 to 2024. For eligibility, a practice must either receive at least 25% of its Medicare Part B payments through the AAPM, or at least 20% of its Medicare patients must be seen through the AAPM.

    In addition to the lump-sum bonus, qualifying participants will not be required to fulfill MIPS reporting requirements, and their Medicare physician fee schedule will increase by 0.75% starting in 2026. If AAPM entities do not meet the criteria, they may choose to participate in MIPS.

    “Many specialists may not have an alternative to the MIPS track due to limited opportunities for specialists to join an Advanced Alternative Payment Model,” said Kane, senior director at Avalere.

    Also see: Urologists, lawmakers share experience, expertise at AACU event

    Under the new rule to take effect in 2018, calculations of MIPS adjustments will include the cost of Medicare Part B drugs, and this change could have a significant impact on payments for some physicians. Physicians who administer more Part B drugs may experience substantial payment variability and financial risk compared with other physicians.

    Next: Specialists bill more often for Part B drugs

    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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