CMS Issues New Physician Reimbursement Rule

The Centers for Medicare & Medicaid Services (CMS) issued the long-awaited proposed rule for implementing the new Average Sales Price (ASP) reimbursement methodology. The proposal is included in CMS' proposed revisions to payment policies under the physician fee schedule for 2005.

CMS estimates that the Medicare drug revenues for hematology/oncology will decline by approximately 8 percent in 2005 as a result of the policies contained in the proposed rule. As this issue of The Hematologist was going to press, ASH was trying to conduct a thorough and comprehensive analysis of the impact of ASP reimbursement on hematologists. However, while the proposed rule included estimated ASPs for 32 drugs, many hematology-related drug prices were not provided, and CMS has stated that it will not be able to provide actual ASPs for all drugs until late November, making it difficult for hematologists to fully understand the impact of this rule on their practices. ASH, therefore, will urge CMS to provide an opportunity to comment on the ASP rates before they are implemented and to continue payment at 85 percent of average wholesale price (AWP) until then. ASH also has been invited to share its analysis with key congressional offices.

The proposed rule also implements provisions from the Medicare Modernization Act (MMA) that increase the update for physician services by 1.5 percent in 2005 and expand the number of preventive services available to Medicare beneficiaries. Had Congress not acted in the MMA, the update for physicians and other providers paid under the Medicare fee schedule would have been reduced by 4.5 percent in 2004 and 3.7 percent in 2005. The rule also implements fee increases for rural and underserved areas. Payments of 5 percent would be made to both primary care and specialty physicians furnishing services to beneficiaries in the areas with the lowest 20 percent of physician-to-beneficiary ratios.

For more information about the proposed rule and to see a copy of ASH's comments, see the ASH Web site at www.hematology.org.

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