Medicare’s Proposed Part B Drug Payment Changes: Understand the Financial and Operational Implications and Weigh In Now!

Event Information
Product Format
Prerecorded Event
Conference Date
Thu, Apr 28, 2016
60 minutes
Product Description

Get a Better Understanding of Medicare’s Proposed Part B Drug Payment Changes and Review its Financial & Operational Impacts

The March 8, 2016 release of Medicare’s Proposed Part B Drug Payment Rule was a surprise to the healthcare industry and had resulted in very strong opinions, comments, and an overall public outcry. A review of the rule uncovers many surprises that providers, suppliers, and manufacturers should be aware of.  The details are many and the answers few, which means now is the time to weigh in with comments.

Providers and suppliers will be placed in control and study groups with the control group continuing to be paid the average sales price for drugs plus 6% (also known as ASP+6%) while the study group clusters would receive ASP + 2.5% + a flat add on amount of $16.80 per drug per day, regardless of the cost of the drug or the type of drug which will result in payment shifts among providers and suppliers.

CMS states that it’s introducing this model to test whether changing the add-on payment of 6% to 2.5% plus a flat fee payment of $16.80 will result in changes to provider prescribing practices and incentives with the hope that such payment reductions along with other value based pricing strategies will lead to improved quality and value. Ultimately, CMS expects to see savings as a result of provider prescribing behavior changes.

While most would agree that drug payment reforms are important, CMS proposal if finalized will likely fall short of what the agency expects, and yet just about all providers will be forced to embark on a 5 year mandatory, national pilot program.  Understanding the financial and operational implications now is vital, especially since providers will randomly be assigned to one of four groups that will test various elements of CMS’ proposal.

Join expert speaker Jugna Shah, MPH, in this informative session to better understand what Medicare has proposed for drug payment policy changes, which if finalized will be a massive overhaul to how Part B drugs are paid.  This “test” is national in scale and mandatory and will impact the vast majority of providers who provide Part B drugs.  This includes physician’s offices, hospital outpatient departments, free-standing clinics, etc. This is only a proposed rule, but if finalized it will have a huge impact so now is the time to understand the specifics and also to weigh in so that the rule is either delayed and/or changed significantly.

Session Highlights:

  • Overview and highlights of CMS proposal
  • Phase I of the Part B Drug Payment Model (begin this fall but no earlier than 60 days after the final rule is out)
  • Phase II of the Part B Drug Payment Model (to begin no earlier than Jan 1, 2017) – this involves a number of value-based pricing options that would impact providers and also manufacturers
  • The expected impact on providers
  • Alternatives that could be provided to CMS
  • Challenging issues that providers should consider and weigh in on now
  • Submitting your comments to CMS now and before May 9, 2016 in order to influence the final rule

Session Agenda:

  • General impressions and industry responses
    • Drivers behind the rule
    • Why the CMS is seeking comments on so many elements?
    • Providers targeted rather than manufacturers!
    • Outcry from industry organizations, trade associations, provider groups etc.
  • Highlights and specifics from the rule
    • Majority of drugs under Part B included
    • Number of drugs excluded
    • Mandatory national pilot program
  • Key items CMS is looking for comments on:
    • Alternatives to the proposed ASP+2.5 percent plus $16.80
    • How should CMS address the unique situation of 340B hospitals?
    • Suitable drugs or group of drugs
    • Types of educational activities CMS should roll out
    • Potential safeguards needed for each of the value-based pricing tools
  • CMS’ Discussion of Impact
  • Key Questions & Issues expected to be raised in comments
  • What are the Next steps?

Who should attend:

Physician’s Hospital outpatient department, finance and revenue cycle directors, free-standing clinic manager and directors, consultants, anyone involved in billing under Part B.

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Order Below or Call 1-844-384-4744 Today

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About Our Speaker

jugna Shah - Hospitals & Healthcare System Coding Expert

Jugna Shah, MPH, is the president and founder of Nimitt Consulting Inc. and specializes in working with hospitals, health systems, advocacy organizations, and international governments on regulatory and health care financing issues. In the U.S., Ms. Shah works with hospitals to manage the clinical and financial operations related to OPPS/APCs.

She also raises important payment system issues to Medicare and the APC Advisory Panel to improve the APC...   More Info
More Events By The Speaker

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