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    Change to Part B pay draws specialty ire

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


    Specialists bill more often for Part B drugs

    Research conducted by Avalere consultants showed that specialists such as oncologists, rheumatologists, and ophthalmologists more frequently bill for Part B drugs compared with physicians from primary care specialties.

    Read: Do you ‘feel the Bern’? What a single-payer system portends

    “As a result, Part B drugs represent a larger percentage of total billed Medicare allowed charges for these specialists,” and they “could see substantially higher payment penalties or rewards than their counterparts who administer fewer Part B drugs,” they noted.

    Moreover, the level of financial risk for certain specialties will continue to rise as implementation of the MIPS program progresses over the next few years. For example, payment adjustments for rheumatologists and oncologists could increase or decrease by as much as 29% in performance year 2020. For urology, Avalere estimated that payments could increase or decrease by as much as 11% during that period.

    Before MIPS went into effect, CMS programs including the Physician Quality Reporting System, Physician Value-Based Payment Modifier, and the Medicare Electronic Health Record Incentive only pertained to physician fee schedule services and did not include the cost of Part B drugs.

    More from Urology Times:

    Survey: Urologists weigh in on MIPS, APMs, burnout

    Bill would lift Stark barriers to APMs

    MedPAC advocates for MIPS termination

    Subscribe to Urology Times to get monthly news from the leading news source for urologists.

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


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