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CHICAGO -- A proposal by the Centers for Medicare & Medicaid Services (CMS) to change the way Medicare pays for drugs under the Part B program would hurt physician practices, the American Medical Association said at its annual meeting here.
"This is a patient care issue and an access issue," said , an ob/gyn in Bronx, N.Y., who spoke on behalf of the American Congress of Obstetricians and Gynecologists. "This will impact care of our patients, especially those with ovarian cancer."
The AMA House of Delegates passed a resolution Wednesday asking that CMS withdraw its proposal and, if that doesn't happen, that the AMA lobby Congress block the proposal's implementation. The proposal, if put into place, "would significantly undermine the ability of physician practices to meet the significant administrative and financial burdens associated with the rapidly evolving healthcare environment," according to the resolution.
The CMS plan would replace the current Medicare reimbursement -- the average sales price of the drug plus a 6% add-on fee to cover costs -- with a rate of the average sales price plus 2.5%, plus a flat fee of $16.80 per drug per day. The flat fee would be adjusted at the beginning of each year.
When the plan was announced, physician groups, particularly in oncology, quickly attacked it as a reimbursement cut. And in early May, 242 House members -- 238 Republicans and four Democrats -- to acting CMS administrator asking him to drop the idea. "CMS's proposed Medicare experiment would impose cuts in Phase 1 that will severely harm patient access to needed drugs," the letter stated. "Under CMS's Medicare drug experiment, numerous physicians would face acquisition costs that exceed the Medicare payment amount for certain drugs."
AMA members spoke uniformly against the proposal. "The reality is that drug control by decreasing prices will not ultimately lower drug costs," said , an oncologist in State College, Pa., speaking on behalf of the American Society of Clinical Oncology. "That's been demonstrated in our practices over and over. We can't let this take place."
The AMA also took other actions Wednesday:
Telemedine. Delegates passed a resolution asking the AMA to develop model legislation requiring telemedicine vendors to provide the patient's established physician with a full record of any telemedicine service performed, including prescriptions provided, studies performed, and any referrals made. The resolution also reiterated AMA policy stating that a valid physician-patient relationship must be established before telemedicine services are provided, and that providers delivering telemedicine services must be licensed in the state where the patient is receiving the service, or provide the services as otherwise authorized by that state's medical board.
Safe Harbor repeal. The group's Board of Trustees will consider a resolution that would urge the repeal of an anti-kickback "safe harbor" for group purchasing organizations. "Even though this is a timely issue, the issue is extremely complex and this is a new policy concern for many people in this house," said , a preventive, occupations, and aerospace medicine physician in Rochester Minn., speaking for the North Central delegation, which supported further study of the issue. "If ... we could get further study, it would provide needed clarification of potential repeal of the safe harbor. GPO contracting directly impacts all of us; it affects the price we pay for drugs and medical devices, which suppliers or hospitals are used for which devices, and it may have important impacts on vendor competition."
Student loan debt. Delegates backed legislation to create savings accounts for student loans that would allow medical students to contribute pretax dollars to pay off their debts.
The AMA's next House of Delegates meeting will take place in November in Orlando.