Proposed changes to Medicare sacrifice patients for cost savings

Officials at the Centers for Medicare and Medicaid Innovation recently proposed a major change to the way Medicare pays for advanced cancer medicines. Unfortunately, the changes threaten cancer patients’ access to lifesaving care.

Many people are familiar with Medicare Part D, which covers prescription drugs that beneficiaries buy at pharmacies. Part B, however, is less well known. It covers drugs administered at clinics or outpatient hospitals for illnesses such as cancer, rheumatoid arthritis and immune diseases.

The agency believes doctors prescribe expensive drugs, rather than clinically appropriate drugs, because under Part B doctors receive a percentage of the drug’s price to cover the cost of administering it. While there is no evidence doctors prescribe the wrong drug so they make more money, the agency nevertheless proposes to “fix” this supposed problem by altering physicians reimbursements.

Doctors who administer a drug under Part B were reimbursed the average sales price of the medicine plus 6 percent. After budget cuts in 2013, Medicare reduced that rate to about 4.3 percent. Now, they’re proposing to cut it to 2.5 percent, but add a flat fee of about $17 each time doctors administer a medicine.

The plan ignores the effect this change will have on patients. Smaller community practices and those in rural communities will drop patients who lack supplemental insurance or send them to major hospitals for treatment; this occurred in 2013 with the “sequestration” budget cuts. The agency’s latest cuts will force more providers to turn away patients.

And if making patients potentially drive hundreds of miles each week for chemotherapy wasn’t enough, the agency proposes to test a host of “value-based care models.” For example, under one model officials would compare a drug’s average life expectancy gains to its cost. If the drug doesn’t meet an arbitrary dollars-todays ratio, it’s considered a bad bargain for Medicare.

Some countries already use cost-effectiveness metrics to restrict doctors’ ability to prescribe advanced drugs. Unsurprisingly, cancer survival rates are lower in those nations than in countries that don’t interfere in doctor-patient treatment decisions.

Who receives the “value” from these models? Is it patients, who potentially lose access to the most innovative, life-saving treatments? Or is it Medicare, which saves money by denying payments for treatments the government decides aren’t “cost-effective.”

The health of millions of Americans hangs in the balance. Given that cancer disproportionately affects older adults, it is likely that if a person develops cancer, he’ll rely on Medicare Part B to cover treatment costs.

Americans must ask themselves: When they or their loved ones develop cancer, do they want to receive the treatment their doctors say will provide the best chance of survival and quality of life? Or do they want to receive only the medicines that government officials deem cost-effective?

Patient health is not something to be toyed with. It’s time for the government officials who tinker with reimbursement formulas to realize that their fiddling has consequences for real people.

Hargis