A Medicare Experiment With a Grim Prognosis

Federal bureaucrats announced earlier this year that they plan to upend the way Medicare Part B pays for drugs. The goal? To save money by getting doctors to alter their treatment choices. That’s bad medicine, flawed economics and destructive public policy—and Congress should pass legislation to stop this ill-conceived experiment.

Medicare plays a crucial role in the lives of more than 55 million Americans. It is the only way some seniors can get access to the drugs that keep them alive. The new policy from the Centers for Medicare and Medicaid Services will jeopardize this access by inserting the government between doctors and patients in an unprecedented way.

ENLARGE

PHOTO: GETTY IMAGES

The idea is to use financial incentives to push doctors to make “value-based care” decisions and prescribe cheaper treatments. Unfortunately, modern-day medicine isn’t as black and white as the administration seems to think. Take cancer care, my specialty. There are very few instances when the substitution of a less expensive cancer drug is appropriate or safe for patients. After all, there is a reason the newer, more advanced drugs—such as those that helped former President Jimmy Carter put his cancer into remission—are considered groundbreaking.

Moreover, it’s hard for doctors to accurately assess what bureaucrats deem to be “valuable,” because no details have been published. How will the government determine if patients can receive drugs or what prices are acceptable? We don’t know. But we are still being asked to allow the experiment to move forward. Don’t worry, bureaucrats say, the government will get things right and won’t leave cancer patients fighting for access to treatment.

More than 300 cancer clinics have closed over the past decade, as Medicare has shrunk payments for cancer care, according to the Community Oncology Alliance. The drastic cuts the Obama administration plans will prompt more closings, especially in rural areas, making it even harder for many cancer patients to be treated. In some communities, oncologists and other specialists already send their Part B patients to hospitals for treatment because they can’t afford to administer it in-house.

The Obama administration frames this experiment as a way to stick it to drug companies and save taxpayers money. They believe that doctors are not prescribing the “right” drugs—meaning the least expensive ones, even if they are the least appropriate. They suggest that doctors are motivated by money, and not their patients’ best interests.

This is a slap in the face to the nearly one million American physicians who have dedicated their lives to patient care. Our patients come first. Period. Every decision we make and every drug we prescribe is for the good of our patients and nothing else. To imply otherwise is untruthful.

From 2009-12, UnitedHealthcare, the largest private insurer in the U.S., conducted a demonstration with community oncology practices that removed any possible “incentive” for doctors to use more expensive cancer drugs. That was very similar to what CMS is proposing now. Yet drug use and spending went up by 179%, according to the Journal of Oncology Practice. The study did not offer an explanation for the paradoxical result.

Research and experiments are vital to oncology. Without them advancements would be limited and the path to a cure much longer. But the experiment that the government is proposing would never be approved by an ethical research institution. Seniors covered by Medicare are forced to participate, and there is no “informed consent” making patients aware of the scope and potential risks. The government has not built in patient safeguards, such as real-time monitoring for adverse events to ensure quality care.

This is not a simple test of a payment model, as the government purports. This is a dangerous experiment on the medical care provided to seniors. It is also as clear a threat to the American health-care system as I have ever seen in my 18 years as a doctor. Congress needs to stand up for America’s seniors and reject this perverse experiment outright.

Dr. Vacirca is CEO and chief of clinical research at NSHOA Cancer Center.