Reform-Minded CMS Doesn’t Let Up on Value Demands

Published on: 
Oncology Business News®, May 2016, Volume 5, Issue 5

A not-so-subtle change in the physician drug payment scheme from The Centers for Medicare & Medicaid Services could be the proverbial straw that broke the camel’s back.

OncLive Chairman,

Mike Hennessy

It’s tough enough managing an oncology practice and incorporating all of the value changes that are now expected of physicians. Now, a not-so-subtle change in the physician drug payment scheme from The Centers for Medicare & Medicaid Services (CMS) could be the proverbial straw that broke the camel’s back. Physicians could hardly stop talking about it at the annual Community Oncology Alliance meeting, held last month, in Orlando. They referred to it as “The Experiment”—under Medicare Part B, the 6% add-on to average drug sales price would be replaced with a 2.5% add-on, plus a flat fee. It is designed to reduce the temptation to prescribe more expensive drugs, but physicians at the conference took umbrage at the implication that oncology is to them a game of maximizing revenues rather than treating patients.


The public comment period on this revision will be over by the time you read this column; and while it’s debatable whether CMS anticipated the strong reaction the proposal would cause, CMS has heard from hundreds of medical groups expressing concern and opposition. Similarly, a huge lobbying effort is under way to spur elected representatives to join in quashing this proposed policy. Read all about it in this month’s Oncology Business Management.

Perhaps CMS is big enough and so well-funded that it can keep many balls in the air at one time, but Dr. Lalan Wilfong, medical director of quality programs for Texas Oncology, explains in our Value in Practice feature this month that not enough thinking and planning went into the new Physician Quality Reporting System (PQRS) from CMS. In his multidisciplinary practice, it has been difficult for oncologists to demonstrate quality because the PQRS doesn’t recognize the type of work that they do and therefore cannot measure the quality of their efforts. This inflexibility in the program has caused some physicians to opt out and expose themselves to the financial penalties for doing so, Wilfong writes.

Our Value in Practice feature, now in its second month, will bring to light the challenges of incorporating value changes while offering guidance from oncology practice administrators on how to manage this transition successfully. Each installment will appear online first at Check there to read Value in Practice in advance of receiving the print edition and also to see past features.

There’s much more in this month’s issue of Oncology Business Management. Our Practice Profile this month takes you behind the scenes at Comprehensive Care Centers of Nevada, a growing practice that enjoys unique advantages based on the union-dominated environment in the Las Vegas area. It also is unique in that its locations conform to prevailing traffic patterns. Practices are farther apart where the driving is easy and closer together where traffic tends to be congested. This enables patients to receive care without encountering significant obstacles to mobility.

This month we also take a close look at one physician’s use of social media to protest a payer’s decision not to cover a drug the oncologist thought would have been appropriate in combination with another therapy for a lung cancer patient. In another story, we look at the controversy that has blown up over the pricing of Xtandi (enzalutamide), a blockbuster medicine that will rightly reward its discoverers and patent rights holders but that prompts the questions “How much reward is enough?” and “What is the responsibility to patients who cannot afford this drug?” Grab a cup of coffee and enjoy this month’s issue of Oncology Business Management!