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Opposing Medicare Part B payment model

Posted By Chet Seward, Tuesday, May 3, 2016

CSEPS joined almost 30 other Colorado organizations in a letter to the Colorado Congressional delegation urging them to intervene and request that the Centers for Medicare & Medicaid Services (CMS) withdraw their proposed rule that would implement a new Medicare Part B drug payment model. CMS is focused on implementing alternative payment strategies and how those efforts affect physician-prescribing patterns, especially for high priced provider-administered drugs. The proposed initiative would greatly impact retina specialists and others who do intravitreal injections. The proposed initiative would reduce the add-on to the average sales price below the current 6 percent that providers are paid to administer drugs. As proposed, CMS would pay this average sales price, plus 2.5 percent. In addition, there would be a flat $16.80 administrative fee. These numbers do not include the current sequestration adjustment, and therefore physicians would only receive a fraction of that add-on. There is a growing backlash as the issue heats up in Congress. Be sure to review more background information from the AAO on this ill-advised proposal,read the letter that CSEPS sent to the Colorado Congressional Delegation and consider writing a letter to CMS yourself (comments are due by May 9). CSEPS will continue to advocate in opposition to this proposed program.

Tags:  Medicare  payment reform 

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