Expert: CMS’ proposed change to Medicare Part B may reverse progress in cancer care
Even though statistics show that over 1.6 million people in the United States will be diagnosed with cancer this year, the death rate in cancer patients has steadily declined as a result of increased knowledge and understanding on how to treat cancer.
According to a report by the American Cancer Society, cancer death rates declined by about 1.5 percent per year between 1991 and 2012. But an expert on cancer care policy and politics says this progress may be reversed if the “misguided” Centers for Medicare & Medicaid Services (CMS) experiment on cancer care moves ahead as proposed.
“It is a national mandatory experiment where CMS, which administers the Medicare program, has made the assumption that all physicians, including oncologists, are prescribing the wrong medication — that they are prescribing medication based on the cost and economic value to the physicians and not what is in the best interest of the patient,” Ted Okon, executive director of the Community Oncology Alliance (COA), told Patient Daily.
Okon also explained in an op-ed that the proposed experiment involves Medicare Part B drugs, which include complex therapies like chemotherapy, that require patients to by closely monitored by physicians during administration.
Based on a theory that decisions oncologists make for their patients are fueled by physicians’ economic interests and not based on the actual medical needs of patients, CMS will try to steer treatment choices towards lower costing cancer therapy, which Okon argues may be less effective.
Okon said a UnitedHealthcare project disproved this misguided notion by removing the financial incentives while working with community cancer clinics.
In 2014, the Journal of Oncology Practice published results of a 3-year UnitedHealthcare program that rewarded quality, not cost of treatment resulted in “significant cost savings” without affecting the quality of care.
“(The study) showed that ‘paradoxically’ spending actually didn’t decrease. So CMS goes in with that experiment which was built on a hypothesis that is incorrect but if you read what they are doing — and it is truly an experiment, it is meant to change clinical decision making,” Okon said.
To run its experiment, CMS has set up a control cell and three test cells, and will randomly select patient care service areas based on zip codes, Okon explained. But seniors have no ability to opt out.
“There is no informed consent that this is going on at all (explaining) that they’re part of a research experiment, and there are absolutely no patient safeguards,” Okon said.
Having run a clinical research network in the past, Okon said it is appalling that this is what CMS is doing “based on a faulty premise to begin with.”
Patients will suffer because drastically cutting reimbursement to independent community and oncology practices will result in the consolidation of such practices into hospitals, which will close sites and limit access. Okon said patients will end up paying more to seek treatment and care in hospitals, as many studies have found.Even more troubling, Okon explained, is arriving at the conclusion that if CMS can use the Innovation Center to overturn a law Congress passed, the Medicare Modernization Act which defines reimbursement, then CMS can also use the Innovation Center to overturn any Medicare law.
“It is government gone wild and it is disconcerting from the standpoint of the government inserting itself between the patient and their physician that makes these decisions in collaboration,” Okon said. “And now you have the government basically, in essence, (defining) what they think cancer care should be.”
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