Advocacy in Action: Physician Payment Rule, Diabetes Awareness Month, and More

  • Nov 2018

What’s Happening in Washington:

Physician Payment Rule – On November 1, the Centers for Medicare and Medicaid Services (CMS) released the final 2019 Physician Fee Schedule rule, which includes a controversial provision to revise the structure of evaluation and management (E/M) codes. CMS significantly revised its original proposal, which we strongly opposed.  We continue, however, to have concerns about the impact on endocrinology.  Key components of the final rule:

  • CMS will pay a single rate for E/M outpatient visit levels 2, 3, and 4 (one for established and another for new patients).
  • Level 5 visits remain unchanged to account for visits with greater complexity.
  • CMS also finalized a complexity add-on code and an extended service code that can be billed with all level 2-4 new and established outpatient visits.
  • As a result of these changes, endocrinologists are expected to receive a 2 percent reduction in Medicare reimbursement when the changes go into effect.
  • CMS will not implement any payment changes until January 1, 2021, which provides us with time to work with the agency and policy makers to further refine these policies.

Here is a chart that shows the dollar values for E/M services related to the final rule. We will provide additional analysis on the final rule in the coming weeks as we formulate a strategy to ensure endocrinologists are appropriately compensated.

Congressional Diabetes Caucus Report – On November 1, the Congressional Diabetes Caucus, a bipartisan group of more than 290 lawmakers led by Representatives Diana DeGette (D-CO) and Tom Reed (R-NY), released a report of proposals to reduce the cost of insulin.  The report calls for capping out-of-pocket costs for prescription drugs that treat chronic conditions, value-based contracts between insulin makers and PBMs, and alternative payment models that move rebates in Medicare.  More details available in the report, Insulin:  A lifesaving drug too often out of reach.

Clinical Care Commission – Three Endocrine Society members, William Herman, Ayotunde Dokun, and Carol Greenlee, were appointed to the new National Clinical Care Commission.  Dr. Herman was also elected to chair the group, which will evaluate and provide recommendations on federal programs related to complex metabolic or autoimmune diseases that result from insulin-related issues, such as diabetes.  More information is available in our press release.

What We Are Working On

Diabetes Awareness Month – November is Diabetes Awareness Month and so we have a number of diabetes-related advocacy efforts underway:

  • DSMT Legislation Campaign – Bipartisan legislation has been introduced in the House of Representatives and the Senate that would expand access to diabetes self-management training (DSMT).  We support this bipartisan legislation and encourage our members to join our campaign and urge Members of Congress to co-sponsor the Expanding Access to Diabetes Self-Management Training Act of 2018.
  • Access to Affordable Insulin – On November 1 we released our position statement on Increasing Insulin Affordability in which we identify several recommendations for stakeholders across the drug supply chain, including:  policy makers, manufacturers, insurers, and the physician community.  More information is in our press release.
  • Twitter Chat – On November 13 from 1:00 – 2:00 PM EST the Society is hosting a twitter chat to discuss diabetes technology.  Society member Dr. Jennifer Sherr, and our Chief Professional and Clinical Affairs Officer Dr. Robert Lash (@rwlash), will be moderating the chat, featuring discussion on what diabetes technology is available now, where diabetes technology could be going in the future, and how to manage the transition from pediatric to adult diabetes care.  Hope you will tune into #EndoChat

 Drug Shortage of Fludrocortisone – Recently, we were contacted by physicians who were concerned about the availability of fludrocortisone tablets, 0.1 mg from Teva and Impax.  We contacted the FDA Drug Shortages Office and learned the following:  Impax states that they continue to have available supply.  Pharmacists can check with their wholesalers for the following Impax products:

  • NDC 0115-7033-01, 100 count bottle
  • NDC 0115-7033-02, 500 count bottle

Teva is currently unavailable, and the FDA is following up with them on an estimated date of return.  For further information regarding their supply, physicians should contact Teva directly.

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