Partnership to Improve Patient Care

  • Home
  • About
    • Mission and Priorities
    • Meet the Chairman
    • Steering Committee
    • PIPC Member List
    • Contact
  • The Issues
    • Value Our Health
    • International
    • Where We Stand
    • Value Assessment Frameworks
    • Engaging Patients in Value-Based Payment
    • Patient-Centeredness in Research
  • Resources
    • Advocacy
    • Letters and Comments
    • PCORI Meeting Transcripts
    • Polling
    • Roundtables
    • White Papers
  • Blog
    • PIPC Patients' Blog
    • Chairman's Corner
    • PIPC Weekly Update
    • The Data Mine
  • Newsroom
    • PIPC in the News
    • Press Releases
    • Open Letter: We Deserve a Voice
  • Events
    • PIPC Forum 2022
    • Discrimination & Health Care
    • C & GT Webinar
    • ICER COVID Webinar
    • Value Our Health Briefing
    • QALY Briefing
    • QALY Panel
    • Past Webinars >
      • ICER SCD Webinar
      • VOH Sickle Cell Webinar
      • Rare Disease Webinar
      • QALY Webinar
      • PCORI Advocacy Webinar
      • APM Webinar
      • Patient Empowerment Webinar
      • Value Assessments Briefing
    • Past PIPC Forums >
      • 2021
      • 2020
      • 2019
      • 2018
      • 2017
      • 2016
      • 2015
      • 2014
      • 2013
      • 2012
      • 2011
      • 2010
  • Home
  • About
    • Mission and Priorities
    • Meet the Chairman
    • Steering Committee
    • PIPC Member List
    • Contact
  • The Issues
    • Value Our Health
    • International
    • Where We Stand
    • Value Assessment Frameworks
    • Engaging Patients in Value-Based Payment
    • Patient-Centeredness in Research
  • Resources
    • Advocacy
    • Letters and Comments
    • PCORI Meeting Transcripts
    • Polling
    • Roundtables
    • White Papers
  • Blog
    • PIPC Patients' Blog
    • Chairman's Corner
    • PIPC Weekly Update
    • The Data Mine
  • Newsroom
    • PIPC in the News
    • Press Releases
    • Open Letter: We Deserve a Voice
  • Events
    • PIPC Forum 2022
    • Discrimination & Health Care
    • C & GT Webinar
    • ICER COVID Webinar
    • Value Our Health Briefing
    • QALY Briefing
    • QALY Panel
    • Past Webinars >
      • ICER SCD Webinar
      • VOH Sickle Cell Webinar
      • Rare Disease Webinar
      • QALY Webinar
      • PCORI Advocacy Webinar
      • APM Webinar
      • Patient Empowerment Webinar
      • Value Assessments Briefing
    • Past PIPC Forums >
      • 2021
      • 2020
      • 2019
      • 2018
      • 2017
      • 2016
      • 2015
      • 2014
      • 2013
      • 2012
      • 2011
      • 2010

The PIPC Blog

Kenneth Thorpe: MedPAC Recommendations Miss the Mark

4/23/2014

 
This post was originally published as an op-ed in The Hill. 

During a recent meeting of the Medicare Payment Advisory Commission (MedPAC, the panel that advises Congress on Medicare policy), proposals put forth could compromise care for millions of Medicare beneficiaries.
​
Of particular concern is applying "least costly alternative" or "comparative effectiveness" standards in Medicare policy, which would shove patients into "one size fits all" Medicare decisions made in Washington.  Under this scenario, if federal officials at Medicare decided that one treatment (for example, a drug, device or surgery) is close enough clinically to another treatment, Medicare payment would be set at whichever treatment was cheapest.
On paper, basing reimbursement on the cheapest available could be perceived as a great way to save money. With financial insolvency projected for the year 2026, Medicare needs to achieve cost savings in order to strengthen its own sustainability. So why not simply set reimbursement levels at the lowest possible level?

In practice it puts Medicare policy in between doctors and patients and takes away doctors' ability to tailor care to the needs of each patient. Without the ability to tailor care to meet their individual patient's needs and preferences, doctors and hospitals must either prescribe the cheapest treatment or pass along the costs of a more appropriate treatment onto the patient. These inherent problems are widely recognized by those, who understand from experience, that their needs are different from other patients with the same condition. In a recent poll conducted by the Partnership to Improve Patient Care (PIPC), respondents overwhelmingly rejected these types of proposals that would allow a government agency to determine which treatments were "best" based on "one size fits all" judgments.

Maybe this could work in a world in which all human beings were identical in their body chemistry, genetic makeup, and health status, but in reality, our population is comprised of an infinite array of genetic and molecular combinations. Consequently, one person might achieve better health from a particular medicine while his or her neighbor may see no health improvement, or even suffer side effects.  This is particularly true for the Medicare population. More than half of those 65 years or older have five or more chronic health conditions, of varying degrees of severity. In treating these patients, physicians painstakingly determine which combinations of medicines, will be most effective in controlling symptoms and enabling healthier lives. By limiting coverage to treatments deemed to be the "least costly," these patients may face barriers and additional costs when seeking the combination of treatments that works best for them.

The "least costly alternative" proposal is just one example of this issue. Patients will face the same challenge as CMS uses its current authority to pursue "bundled payment policy" that relies on rigid treatment protocols and care pathways to achieve savings. This policy operates on the same principle - assume treatments are equal on average and ignore wide variation in patient needs. In a recent Clinical Cancer Research journal article, leaders in the cancer community highlighted concerns with these types of policies, saying that these "approaches, which relied on static, point-in-time evaluations based on broad population averages, seem to be particularly challenged by the emerging science in oncology, by the growing emphasis on patient engagement and patient centeredness, and by the new era of personalized cancer care that these changes are driving." 

The MedPAC discussion raises a pivotal question - should saving money take precedence over prescribing the most effective treatments?  Should we even have to ask that question? Wouldn't it be far preferable to have a serious national discussion about ideas that could bring greater value and cost-effectiveness to Medicare without denigrating the quality of care patients receive?

We could certainly make Medicare a stronger program, in a financial and healthcare sense, if we invested in early interventions and innovative therapies to attack chronic disease, spending relative pennies to keep people healthy instead of large dollar amounts to treat symptoms that have exacerbated.  In fact, a number of care models, such as patient-centered medical homes, intensive monitoring and care coordination for patients after they leave the hospital, and chronic care self-management are making a difference in both lowering costs and improving outcomes. 

We cannot achieve a healthier society simply by making investments based on what is the cheapest. No patient wants to, or should, feel squeezed into a "one size fits all" treatment plan. MedPAC's proposed "least costly alternative" policy is the wrong policy in the wrong place at the wrong time. 
​
Kenneth Thorpe, Ph.D., is chairman of the Partnership to Fight Chronic Disease (PFCD) and a Robert W. Woodruff professor and chair of the Department of Health Policy & Management in the Rollins School of Public Health at Emory University, Atlanta, Georgia. He also co-directs the Emory Center on Health Outcomes and Quality. He was deputy assistant secretary for Health Policy in the U.S. Department of Health and Human Services from 1993 to 1995. ​

Comments are closed.

    Topics

    All
    Alternative Payment Models
    Chairman's Corner
    Patient Centered Research
    PIPC In The News
    PIPC Patient Blog
    PIPC Weekly Update
    Press Releases
    The Data Mine
    Value Frameworks

    Archives

    February 2023
    January 2023
    December 2022
    November 2022
    October 2022
    September 2022
    August 2022
    July 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    January 2022
    December 2021
    November 2021
    October 2021
    September 2021
    August 2021
    July 2021
    June 2021
    May 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    April 2013
    March 2013
    December 2012
    November 2012
    February 2012
    September 2011
    August 2011
    July 2011
    May 2011
    March 2011
    November 2010
    October 2010
    September 2010
    August 2010
    April 2010
    March 2010
    February 2010
    December 2009
    September 2009
    July 2009
    June 2009
    May 2009
    February 2009
    January 2009
    December 2008

About PIPC
The Issues
Resources
Blog
In the News
Press Releases
Contact Us
100 M Street, SE – Ste. 750
Washington, DC 20003