Perry isn't alone in his feelings that the agency has become unpredictable and unresponsive to data-backed worries over its proposals. A series of rulemakings released earlier this month spanning 4,000 pages seems to undermine statements from agency officials that they want to make Medicare less burdensome.
"The overall theme is that the one thing hospitals have to count on is that we're going to have significantly lower revenue in the future," said William Ferniany, CEO of the University of Alabama at Birmingham Health System.
The rule-o-rama also added fuel to a debate on how committed the agency is to moving from a fee-for-service system to one that focuses on value and quality.
While Genesis was spared from the 340B cuts since it's a sole rural community hospital, Perry isn't sure if that protection will hold in future years. He believes it's likely the agency will revisit the program again with additional cuts.
His loss of trust in the agency's decisionmaking is giving him pause about taking on risk under one of the Medicare alternative payment models, a choice that's now his to make since the CMS is making participation voluntary.
"There's a lack of predictability about what's coming next, and that uncertainly hurts industry's ability to truly innovate," Perry said.
The CMS has countered that the 340B reduction is not a cut, but a redistribution. Savings from 340B will be funneled into higher overall payments for all hospitals under the outpatient fee schedule. Starting in 2018, the CMS will pay just over $65,000 for a drug that costs $84,000, compared with $89,000 under the current construct. Payment for vaccines will not change.
The University of Tennessee Medical Center may lose as much as $13 million as a result of the change. For a safety-net hospital whose patient mix includes 9% uninsured and 26% Medicaid, that's a major loss, according to Steve Ross, senior vice president of strategic development at the facility.
He is aware of the CMS' promise to redistribute the funds, but said the agency hasn't provided enough details.
"They haven't described it to us yet, so you are taking that on faith," Ross said.
What is clear is that his hospital won't get back all it lost. In the final rule, the CMS predicted that not-for-profit and public hospitals are going to receive reductions under the policy while for-profit hospitals are expected to receive an increase.
Hospital leaders also contend that the latest rulemaking adds to an already confounding regulatory arrangement. Riverside Health System, a regional provider based in Newport News, Va., has two full-time employees who do nothing else but oversee 340B, said Cindy Williams the system's vice president and chief pharmacy officer.