Tweet

LogixHealth Analyzes the CMS Proposed Rule Related to Medicare Part B Prescription Drug Models

BEDFOR, MA — (Marketwired) — 03/17/16 — , a leading provider of internet and software enabled coding, billing, analytics and management services for hospital and physician practices nationwide, provides services for millions of Emergency Department (ED) visits across 35 states, and has analyzed the implications of the CMS Proposed Rule to test new Medicare Part B prescription drug models.

In 2015 prescription drug spending totaled $457 billion representing 16.7 percent of health care spending, and Medicare Part B spent $20 billion on outpatient drug benefits. The Centers for Medicare & Medicaid Services (CMS) has announced a proposed rule to test new drug payment models that include patient and physician incentives, and that reward improved outcomes. According to Andy Slavitt, Acting CMS Administrator, “These proposals would allow us to test different ways to help Medicare beneficiaries get the right medications and right care while supporting physicians in the process.”

Medicare Part B generally reimburses covered medications based upon the average drug price, plus a six percent add-on. Physicians can choose among multiple drugs, yet the current Medicare payment methodology can actually penalize doctors for selecting clinically appropriate lower-cost drugs. The proposed model would test whether changing the add-on payment to 2.5 percent plus a fixed payment of $16.80 per drug per day would incentivize the best choices for patients.

The proposed rule would also significantly decrease patient cost sharing for the most effective drugs, and over time would vary the payment based upon clinical effectiveness. “The restructuring of CMS– reimbursement for prescription drugs further highlights the continued push towards value based purchasing of healthcare services” states Michael Granovsky, MD President of .

CMS proposes to create a control group and a study group. One group would remain under the six percent add-on arrangement and the second would receive 2.5 percent of the average drug price plus a flat $16.80 per drug per day payment.

CMS is accepting comment on the proposed rule through May 9, 2016.

The proposed rule is available at

, a leading provider of internet and software enabled coding, billing, analytics and management services for hospital and physician practices nationwide, provides services for millions of Emergency Department (ED) visits across over 35 states. We provide tools and resources to optimize financial performance and improve the quality of care. For more information, visit .

LogixHealth