Feds consider exemptions to controversial Medicare Part B payment model

After facing a great deal of backlash about their proposed Medicare Part B payment model demonstrations, federal regulators say they are considering tweaking the models to exclude some oncology practices.

The new payment models are intended to test ways to incentivize patients and doctors to choose less expensive but still high-performing drugs administered at medical facilities. Physician and pharmaceutical groups have slammed the proposal, saying the new models prioritize cost control over patients' access to life-saving treatments.

But the Centers for Medicare & Medicaid Services (CMS) might consider excluding practices from its new Part B payment models that are already participating in a separate Oncology Care Model demonstration, CMS Principal Deputy Administrator Patrick Conway said Monday at a Pew Charitable Trusts panel, according to Inside Health Policy. If CMS does include those practices in its Part B demonstration, he said, it actually might make it more difficult to determine if the demonstration is successful.

At another event Monday--sponsored by the Pharmaceutical Care Management Association--CMS Deputy Administrator and Medicare Director Sean Cavanaugh expressed a similar viewpoint, the article adds.

Conway also stressed that CMS is striving to take into account stakeholders' comments as it prepares to finalize its rule, The Hill reports. "We thought we expressed this well in the proposal, but we've heard from some patient groups, so I want to say this clearly: We hear you, and we will deeply engage patient and consumer communities in this model," Conway said.

Meanwhile, a new analysis from Memorial Sloan Kettering Cancer Center's Peter Bach, M.D. finds that CMS' proposed Part B payment models would in fact reduce the financial incentive for oncologists to prescribe more expensive treatments. Yet while the proposal would allow many less-expensive drugs to see larger profits, few expensive drugs will see their aggregate profits drop significantly.  

To learn more:
- here's the Inside Health Policy article (subscription required)
- read The Hill article
- check out Dr. Bach's analysis

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