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2019 Physician Fee Schedule and Quality Payment Program Proposed Rules Released


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The Centers for Medicare & Medicaid Services (CMS) released its proposed rule for 2019 Medicare physician reimbursement. 

CMS estimates that in 2019, the overall impact for the hematology/oncology specialty will be a 4% reduction in reimbursement and a 2% reimbursement reduction for radiation/oncology. These overall impacts reflect statutory adjustment factors, related to the Medicare Access and CHIP Reauthorization Act and Relative Value Units of CPT codes. It is important to note that the actual impact on individual physician practices will depend on the mix of services the practice provides.

Furthermore, under Medicare Part B, CMS is proposing to reimburse new drugs and drugs that do not have a reported Average Sales Price at Wholesale Acquisition Cost (WAC) +3%. New Part B drugs are currently reimbursed at WAC +6%.

ASCO has serious concerns about these cuts and will outline them for CMS in comments to the agency during the proposal’s open comment period, which closes on September 10, 2018.

The proposal also includes changes to the Quality Payment Program (QPP) for 2019. While ASCO is still analyzing the proposed rule and assessing its full potential impact, a key update for cancer care providers in the Merit-Based Incentive Payment System (MIPS)—one of QPP’s two tracks—is in the weighting of performance categories and the overall score needed to avoid a negative payment adjustment. The 2019 QPP proposal would weight the MIPS Quality category at 45% of a provider or practice’s total MIPS score (down from 50% in 2018); Promoting Interoperability (formerly Advancing Care Information/Meaningful Use) would remain at 25%; Improvement Activity would also remain 15%; and the Cost category would increase to 15% (from 10%). The performance threshold is also slated to go up to 30 points (from 15 points) to avoid a negative payment adjustment.

The MIPS performance period will be 12 months, starting January 1, 2019. 

For updates on the latest rules and cancer policy news, visit asco.org/ascoaction. ■

© 2018. American Society of Clinical Oncology. All rights reserved.


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