CMS considers modifications to ambitious Medicare Part B payment experiment

In an attempt to salvage a controversial experiment aimed at curbing rising drug costs, Medicare Deputy Administrator Patrick Conway on Tuesday told the Senate Finance Committee that CMS is closely evaluating the comments it has received on its proposed changes to physician reimbursements under Medicare Part B, according to The Washington Post.

In March, CMS said it would test new Part B payment models to encourage physicians to select the most effective treatment for patients who require expensive medications, such as drugs for cancer, macular degeneration, rheumatoid arthritis, some immune system diseases and other conditions. The payment changes under the experiment would reduce payments to hospitals and certain specialists while increasing payments to primary care providers.

Currently, Medicare pays physicians and hospital outpatient clinics the average sale price of a drug plus 6 percent. Critics of this system say the additional 6 percent could incentivize physicians to prescribe more expensive medications. The new formula would reimburse physicians a 2.5 percent add-on and a flat fee for each day a drug is administered.

Mr. Conway told Senate Finance Committee members his agency is using the comments to determine if any adjustments should be made before the experiment is finalized. For instance, CMS is reviewing the nationwide scope of the experiment, as well as its impact on rural areas and small medical practices, according to The Washington Post.

The experiment has received bipartisan opposition from senators, with Republicans calling for the proposal to be scrapped entirely, and Democrats who have raised concerns of their own.

Committee Chairman Orrin Hatch (R-Utah) said the experiment was "ill-conceived and likely to harm beneficiaries," according to the report. Sen. Tom Carper of Delaware (D) questioned why 75 percent of the country has to participate in the experiment. "Why such a large, expansive demonstration?" he said.

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