Senators push CMS to rethink Medicare Part B payment proposal

Both Democrats and Republicans in the Senate have added their voices to the rising chorus of concern about the Obama administration's proposal to test new payment models for Medicare Part B.

The proposal, unveiled in March by the Centers for Medicare & Medicaid Services, aims to design incentives for patients and physicians to select lower-cost, high-performing drugs that are administered at medical facilities. But it has drawn fire from pharmaceutical manufacturers and provider groups, which argue the proposal puts cost concerns ahead of access to life-saving treatments.

Now, politicians have jumped into the fray.

In a letter sent this week to CMS Acting Administrator Andy Slavitt, Republican members of the Senate Finance Committee called for the agency to withdraw its Part B proposal, writing that "it would severely disrupt care" for some of the most vulnerable Medicare beneficiaries.

In addition, "we find the process by which CMS developed the proposals as concerning as the policies themselves," the letter states, citing a lack of oversight, the unprecedented scope of the experiment, and what senators say is the failure of CMS to consult outside experts about the proposal.

Senate Democrats didn't go as far as advocating for CMS to scrap its proposal--they instead outlined concerns they say they've heard from patients, providers and other stakeholders.

The lawmakers say that before moving forward with the model, CMS should: ensure beneficiaries have continued access to Part B medications and quality of care; maintain appropriate access to community-based care; and achieve alignment with existing delivery and payment reform models.

Like the Republicans, they also criticized the breadth of the payment model demonstrations, noting that "as a general principle, [the Center for Medicare and Medicaid Innovation] should initially implement focused demonstrations, which, if successful, can be adopted by the Medicare program."

In response to criticism of the proposal, CMS officials have indicated that the agency might consider excluding oncology practices that are already participating in a separate Oncology Care Model demonstration.

To learn more:
- here's the Senate Republicans' letter
- read the Senate Democrats' letter

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