Victory! Patients win Medicare Part B fight

Patient Victory: Controversial Changes to Medicare Part B Shelved

Higher insurance premiums. Barriers to access. Denial of the right treatment. There’s seemingly bad news around every corner.

Here’s some good news for patients to cheer: After speaking up, patients have blocked a controversial change to Medicare Part B.

Earlier this year, we warned about a proposed change to Medicare Part B that would jeopardize patient access to care at community clinics, reduce innovation and force more patients to “fail first” with ineffective treatments.

Medicare Part B determines access for cancer patients

Most patients are probably more familiar with Medicare Part D, which covers the most common prescription drugs. But, Medicare Part B has a major role in covering treatments for cancer patients.

Without consulting patients, the Centers for Medicare & Medicaid Services sought to change the cost and reimbursement structure. As the Community Oncology Alliance explained it, “The CMS Medicare Part B Drug Payment Model intends to drive the selection of cancer drugs towards the CMS definition of ‘value,’ rather than the most appropriate treatment determined by oncologists in close collaboration with their patients.”

Based on the concerns of cancer patients, we joined more than 300 health care organizations in opposing the CMS proposal.

“We believe that this type of initiative, implemented without sufficient stakeholder input, will adversely affect the care and treatment of Medicare patients with complex conditions, such as cancer, macular degeneration, hypertension, rheumatoid arthritis, Crohn’s disease and ulcerative colitis, and primary immunodeficiency diseases,” read a letter co-signed by Patients Rising and 315 other health care organizations.

Cost-saving proposal forced more patients into expensive hospital setting

In particular, oncology advocates expressed concerns that the “cost-saving” proposal could force more patients to receive care in more expensive hospital settings.

“It is an understatement to say that this latest CMS initiative is misguided and a perilous cancer care policy,” wrote Ted Okon, executive director of the Community Oncology Alliance. “It will only serve to accelerate the consolidation of cancer care into the more expensive hospital setting and undermine the physician-patient collaboration on the treatment of cancer. I thought we were at war on cancer, not cancer care.”

Late last month, reported that the proposal was effectively “dead in the water.”

“The proposal hit a brick wall of opposition, consisting of specialty societies such as the American Society of Clinical Oncologists, the American Academy of Ophthalmology (AAO), and House Republicans, who all warned that reduced payments would dissuade many physicians from administering Part B drugs, hurting patient access to treatment in the process. Even some House Democrats sounded alarms about the potential impact on patient care,” Medscape reported.

Now, the Obama administration has officially confirmed it’s over.

“After considering comments, CMS will not finalize the Medicare Part B Drug Payment Model during this Administration,” an agency spokesman told POLITICO.

Defeat of Medicare Part B Experiment = Patient Victory

Our take: Give yourself a round of applause. This is another win for patient engagement. We’re proving that the patient voice is a powerful tool in shaping health care policy.

“It is clear that the pressure we put on Congress played a big part in driving the delay and ultimately death of the Part B experiment,” the Community Oncology Alliance said in a statement released last month.

It is our belief at Patients Rising that when we get so focused on cost at the exclusion of all other factors, we lose sight of the patient’s best interest. When we lose sight of the patient’s value and best interest, we have failed.

“The most appropriate treatment for a patient should be determined by the patient and their doctor. Period,” Terry Wilcox, our co-founder and executive director explained in a post on the impact to seniors. “If a value payment model of any kind does not put that relationship and decision making process at the top of the pyramid then it is a failure.”

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