Myth: “If you like your doctor, you can keep your doctor.”

All CANCER PATIENTS WITH MEDICARE may soon be forced to go only to hospitals for their treatments by this Summer or Fall. Not just cancer patients, but anyone being treated with any medications billed to Medicare Part B (that’s the doctor part of Medicare). You may not be able to pick your cancer or other chronic illness doctor anymore if you live in certain selected urban zip codes.

My oncologist’s office just called me Friday to ask if my mom and I would ADVOCATE on their behalf to stop a bill called Medicare Part B Drug Payment Model/Experiment. It just so happens, I had lunch with one of my Congressman’s aids today. We spoke about this and he said, “Email me with all these details and I will see the Congressman gets it.”

This is a regulation that is going to be implemented and “voted” on by faceless regulators May 9th. Call your Congressman and Senator, so they can urge CMS (Center for Medicare and Medicaid Services) to stop this shortsighted regulation from going into effect.

Regulation text and comment here under “Medicare Program: Part B Drug Payment Model” (ID: CMS -2016-0036-0002)   Link: https://www.regulations.gov/#!documentDetail;D=CMS-2016-0036-0002

My comment:

This “experiment” could easily be done with volunteer patients and hospitals to study if the drug cost savings is worth any potential downside of patient care or outcome. It should not be forced upon the unwilling.

I am receiving cancer treatment at my oncologist’s office. I do not want to go the hospital for treatment because my doctor doesn’t provide his outpatient treatment services at the hospital. I have a doctor and want to keep him! He does see his patients in the hospital when they are sick, so he has hospital rights. He also has a private practice for a reason, probably because he doesn’t want to work in hospital.

CMS will end up rationing care as hospitals eventually have less competition from private practices. I can see it now, soon routine hospital cancer treatment will be as terrible as the Veterans’ Administration.  In case you don’t know, that’s bad for patient outcome.

This shortsighted and foolish CMS regulation will put my doctor’s practice out of business. That is bad for patient outcome too.

Haven’t we been told that hospital care is the most expensive care? Haven’t we all been urged by our insurance companies and employers to go to UrgentCare-type places on the weekends or evenings when our doctor’s offices are closed instead of going to the ER?? Why are we now being asked to go the hospitals for routine office treatments?? How on earth will that ever lower costs?

Straight from the Regulations.gov text:

The proposed Medicare Part B Model would test new ways to support physicians and other clinicians as they choose the drug that is right for their patients. It is designed to test different physician and patient incentives to do two things: drive the prescribing of the most effective drugs, and test new payment approaches to reward positive patient outcomes.

So, “most effective drugs” and “positive patient outcomes,” probably means different things to different people. “Positive” for who?  The government payer?

In the context of government cost savings, it probably doesn’t take into account quality or quantity of life. But an inexpensive drug that lowers your blood pressure numbers, but you still have a heart attack and die, could be deemed effective by the government. And if you’re dead, that controls costs. Do you see where this is going?  A cheap cancer drug that lowers the cancer marker number, but patient still dies, does lower the costs. While a more expensive cancer drug might lower that number as well as keep the patient alive longer.

But “most effective” might only allow for $10 drugs, not $100 drugs. The government has a very low bar of expectation for medical care. Please read about the deplorable conditions at Veterans’ Administration hospital around the country. (No one has lost their job yet.)

How?

“Overall, spending on drugs furnished in the office setting increases while spending on drugs furnished in the hospital setting decreases.”

The government has figured out how to control prices by manipulating behavior. How very Cloward and Piven of them. They say it right here,

“We intend to achieve savings through behavioral responses to the revised pricing,…”

Could it be rationing or is it simply a way to over-burden private practices with new responsibilities and lower prices??

“The monthly PBPM care management payment supports infrastructure and organizational change to meet the [Oncology Care Model] OCM requirements, such as 24/7 access to care, and assists participating practices in effectively managing and coordinating care for oncology patients during episodes of care, while the potential for performance-based payment will give practices incentives to lower the total cost of care and improve care for beneficiaries during treatment episodes.” [underline added]

The path of total lower costs (i.e., reimbursements from Medicare) and improving care (forced conditional regulatory care) is bankruptcy. Just like we are seeing in Obamacare, doctors and hospitals are forced to “cover” a long list of services as preventative and free to the patient. And what is happening to these insurance companies? Recently, they have announced they will leave certain states/populations because they are losing billions. What happens then? Less competition. With less competition, prices always increase for the consumer.

Which providers are involved?

§ 511.100

Included providers and suppliers.

General. This model requires mandatory participation for the providers and suppliers (including physicians) who furnish Part B drugs that are included in the model if the provider or supplier is located (or services are billed) in the geographic areas that are selected for inclusion in the model.

Oh, good.

Where?

§ 511.105

Geographic areas.

(a) General. The geographic areas for inclusion in the Part B Drug Payment Model are obtained through stratified random assignment of PCSAs to each model arm.

(b) Exclusions. PCSAs with any ZIP code located in the state of Maryland are excluded from this model.

No list of zip codes were provided in the regulation language. I guess CMS will have to pass it see who is effected?

READ IT here: https://www.regulations.gov/#!documentDetail;D=CMS-2016-0036-0002

Click the blue “COMMENT NOW” button in the top right of the page to leave CMS a comment.

Regulations.gov ID: CMS-2016-0036-0002