A top Obama administration official called on Republicans and doctors to prove that a controversial experiment on Medicare payments will hinder access to treatments as the GOP claims.
“If people can show that a change in a small rural practice or oncology practice, there would be an impact to patients, we would want to know about that,” said Patrick Conway, deputy administrator of the Centers for Medicare and Medicaid Services.
His comments at a briefing held by the Alliance for Health Reform and the journal Health Affairs is in response to lawmakers and doctors’ concerns about an experiment to get doctors to prescribe cheaper drugs under Medicare Part B. Earlier this week more than 200 House lawmakers wrote to CMS slamming the experiment.
“People are raising issues that we need to think about,” said Conway, who added that the agency will address their concerns.
Lawmakers aren’t the only ones with concerns about the model. A collection of more than 300 advocacy groups, including doctor groups for Alzheimers and cancer, wrote to the administration in March saying that there is no evidence the model will help improve the quality of care.
Conway noted that some doctors and oncology practices have reported that “drug revenue is over half of their revenue. I think one could call that interesting.”
When questioned about what he meant, Conway said that he believes that “most physicians do prescribe medicines on what is best for their patients.”
He added that oncology centers have largely been telling CMS that they want to ensure that their revenue is more dependent on care and not just on drug revenue.
Medicare Part B reimburses for expenses such as doctor visits. It also reimburses doctors for drugs that are administered in a doctor’s office, such as chemotherapy treatments.
Currently the reimbursement includes a payment for the average sales price of the drug and an additional 6 percent of that price. For instance, for a drug that costs $6,000, the doctor would receive that amount plus $360.
CMS has said that model incentivizes doctors to prescribe more expensive drugs, even if they aren’t necessary. It proposes to change it to the cost of the drug, 2 percent and a small fee of $16 per drug.
Officials said the goal of the experiment, which hasn’t been created, is to get doctors to help lower healthcare costs by prescribing the necessary treatment.
“The proposal was to try to remove the financial consideration from the prescribing of medicines,” Conway said.
Republicans and some doctor groups, however, are concerned that the experiment gives the government too much power over healthcare.
“It creates disincentives for treating patients who depend on Medicare, including those with cancer, rheumatoid arthritis, rare diseases and neurological disorders,” said Rep. Tom Price, R-Ga., chairman of the House Budget Committee.
Conway said CMS is reaching out to lawmakers to address their concerns.
“We want to work with lawmakers,” he said.
He added that CMS is open to adjusting the experiment and payment model based on the concerns, especially when it comes to rural health centers and oncology practices.
