1. PIPC Poll: Americans Support Patient-Centered Solutions, Oppose Government Determining Value, click here to view the full survey results.
2. PIPC Patient Access Alert: CMS’ Part B Demonstration, click here for details.
3. Turning the Tide Against Cancer, click here to view policy considerations.
4. CMS to Launch New Primary Care Payment Model, see details below.
5. PCORI Board Chair: Changing the Conversation about Mental Health Research, click here to view the op-ed.
6. How One Doctor Turned to His Patients — Over Pie — to Simplify Medical Advice, click here to view the article.
7. Washington Post: ‘How do you feel?’ Doctors are starting to pay attention to the answer, click here to view the article.
8. PCORI Blog: Supporting Patients' Roles in Their Healthcare Decisions, click here to view the blog post.
9. LAN Consumer and Patient Affinity Group Principles, click here to view the draft.
The Partnership to Improve Patient Care (PIPC)—whose members include organizations representing patients, people with disabilities and other stakeholders—today released a public opinion poll regarding healthcare delivery and access in America. The survey, which builds on prior surveys conducted by PIPC in 2013 and 2015, shows that of nearly 2,000 registered voters polled by Morning Consult, 8 in 10 say that doctors and patients should be able to decide the best course of treatment without government interference and that Medicare reforms should move toward patient-centered health care by giving physicians and patients the support they need to choose the best care for them.
This survey follows the Centers for Medicare & Medicaid Services’ (CMS) recently proposed new Part B Drug Payment Model, calling for government-determined centralized value determinations based upon comparative effectiveness and cost-effectiveness analyses. Consistent with the poll’s findings, PIPC is strongly opposed to putting CMS in the position of deciding value on behalf of patients, which would create substantial new barriers to patient access, and undermine the movement toward patient-centered healthcare. Indeed, the survey finds that 7 in 10 voters oppose allowing CMS to determine what is valuable for patients based on an average.
The survey demonstrates that voters resoundingly reject the main tenets of the CMS proposal.
Additional key findings include:
9 in 10 voters agree that health care decisions should be made between doctors and patients6 in 10 voters oppose government efforts to set national protocols for medical care to promote mindful prescribing by physicians for Medicare patients2 in 3 voters do not think the government should try to save money by setting preferred courses of treatment for diseasesMore than 6 in 10 voters oppose government deciding when drugs are similar on average in order to give prescribers incentives to use certain drugsFinally, 86 percent of voters think it is important to maintain the current Medicare safeguard that prohibits the government from using cost-effectiveness in making coverage or payment decisions because it may discriminate against seniors and people with disabilities.
PIPC Chairman Tony Coelho stated, “This survey highlights the importance of PIPC’s long-standing efforts to support patient-centered approaches to comparative effectiveness research and payment and delivery reform, and strong concern with the one-size-fits-all approach taken by the Centers for Medicare and Medicaid Services (CMS) in its March 8 proposed rule. PIPC has worked too hard and too long to give patients a meaningful voice in health care decisions to go back to sidelining patients in their own care decisions; we urge CMS to withdraw this proposed rule and instead embrace solutions that will put patients at the center of value.” Click here to view the full survey results.
2. PIPC Patient Access Alert: CMS’ Part B Demonstration
On March 8, 2016, the Center for Medicare and Medicaid Services (CMS) proposed a new Part B Drug Payment Model. Among its provisions, the proposal calls for use of comparative effectiveness research (CER) and cost-effectiveness reports as the basis for national Medicare policy, in direct conflict with the patient-centeredness movement. Since its inception, the Partnership to Improve Patient Care (PIPC) has been strongly opposed to misuse of CER and cost effectiveness in government policies. This proposal appears to have been rushed forward with little or no patient input. The phase involving centralized use of CER and cost-effectiveness begins early in 2017, eventually covering 50% of providers and patients, leaving little time for meaningful patient engagement. PIPC and its members will develop their own comments to the agency in the near future and will share them in advance of the May 4, 2016 deadline. In the meantime, background materials on the implications of centralized value assessments for patients are available here. Implications for patients are summarized as including:
One-Size-Fits-All Policies Set Back the Drive for Patient-Centeredness Relies on Payer-Centered Approach Centralized Value Assessments Rely on Average Results that Ignore Patient Differences Undermines ACA ProtectionsPIPC’s recent alert to members and links to PIPC Chairman Tony Coelho’s statements on the issue are available here. In advance of the comment period deadline on May 9, 2016, PIPC will share its own comments with members - so keep checking our web page this week! Other organizations weighing in on the proposal include the National Infusion Center Association and the Arthritis Foundation.
3. Turning the Tide Against Cancer Policy Considerations
In an article published this week in the AACR's journal Clinical Cancer Research, the Turning the Tide Against Cancer (T3) co-conveners highlight five policy considerations considered critical to ensuring alternative payment models, clinical pathways, and shared decision-making tools enable the delivery of high-quality oncology care, while supporting innovation. PIPC played an advisory role in the development of the T3 policy considerations, and we are excited to see them published! Click here to view the article.
4. CMS to Launch New Primary Care Payment Model
Last week, the Centers for Medicare and Medicaid Services (CMS) announced a new initiative aimed at changing payment incentives so that doctors have more freedom to choose how to care for their patients. The new payment program, called Comprehensive Primary Care Plus, is intended to shake up the way 20,000 doctors and clinicians treat more than 25 million patients when it goes into effect January 2017. The initiative marks a significant departure from the current “fee-for-service” system, which offers reimbursements per visit or procedure. Under the new program, part of doctors’ payments will include a monthly fee to pay for a certain group of patients, freeing up doctors to talk on the phone, email their patients or set up longer visits outside of the usual structure. The initiative is part of a larger Administration effort to move the healthcare system away from paying simply for the number of procedures or visits and toward rewarding quality health outcomes for patients, using authority the 2010 health law gave to an innovation center able to test out new payment models.
CMS says the program will be implemented in up to 20 regions of the country, covering 20,000 doctors and 25 million people. The new initiative is voluntary, so doctors can choose to join if they wish. The program also seeks to partner with private health insurers so that the payment changes come not just from Medicare but from private health insurance as well. Most of the attention devoted to the ACA has involved its coverage expansion for the uninsured and its new rules governing insurance, but its little-noticed changes to the actual delivery of care could be just as consequential in the long run. This new five-year primary care initiative would be its most ambitious delivery reform yet, designed to serve twice as many Americans as are now enrolled in the higher-profile ACA exchanges.
Meanwhile, the CMS Alliance to Modernize Healthcare (CAMH) is now soliciting candidates for a new LAN work group focused on primary care. This new work group will include experts who will collaboratively develop recommendations on the critical components for primary care payment in category 3 or 4 alternative payment models (APMs) and make practical recommendations for accelerating adoption of these models, including steps to support implementation. The initial work group deliverable will be a white paper that includes actionable recommendations within a 12-24 month time frame. Click here for details and to apply.
5. PCORI Board Chair: Changing the Conversation about Mental Health Research
Last week, Morning Consult published an op-ed on mental health by PCORI Board Chair Gray Norquist. “[A]s both a psychiatrist and chairperson of the Board of Governors of the Patient-Centered Outcomes Research Institute (PCORI), it’s essential to me that we keep the concerns and outcomes most important to patients firmly in mind as these discussions continue. This is critically important not only in the treatments we suggest but also in the research we conduct to inform those care options. That’s the only way I know to offer patients, their families, and all of the clinicians who work with them the care options they’re likely to find useful. This is the approach PCORI has taken since we first began funding research under our Congressional mandate to produce evidence that patients, clinicians, insurers, employers and others can use to make better-informed health and healthcare decisions.” Click here to view the op-ed.
6. How One Doctor Turned to His Patients — Over Pie — to Simplify Medical Advice
An op-ed penned by PCORI-funded researcher Jack Westfall appeared last week in the First Opinion section of the health news outlet STAT News. This piece stems from the research he and his co-authors wrote about for the April issue of Health Affairs. “As I discovered, patients are key to translating into plain English the stilted, often arcane language of evidence-based recommendations. Equally important, organizations like the Patient-Centered Outcomes Research Institute are changing the culture of research by getting patients involved in the process earlier and earlier, even contributing to the design of clinical trials. This helps researchers make sure they're addressing the right problems, asking the right questions, and studying the right diseases.” Click here to view the article.
7. Washington Post: ‘How do you feel?’ Doctors are starting to pay attention to the answer.
Last week, the Washington Post carried a feature article that quoted PCORI-funded researcher Danielle Lavallee talking about the patient-centered research she wrote on for the April issue of Health Affairs. “It may seem like a no-brainer to include patients’ assessments of their physical and mental conditions and quality of life into medical care, but such patient-generated data has traditionally been confined to research rather than clinical settings. Clinicians have typically focused more on such things as physical exams and medical tests to guide patient care. However, as patient-centered medical care has taken hold in recent years, there has been a growing interest in finding ways to use outcomes reported by individuals to help guide care.” Click here to view the article.
8. PCORI Blog: Supporting Patients' Roles in Their Healthcare Decisions
As PCORI Executive Director Joe Selby and PCORI’s Jean R. Slutsky commented last week on The PCORI Blog, “At PCORI, we're interested in the potential for shared decision making to enhance and support patients' involvement in healthcare decisions. We were established to fund studies that will produce evidence to help patients and those who care for them make better-informed choices about their healthcare options...Given that focus, we're pleased to have supported the latest issue of the journal Health Affairs, which addresses patient and consumer use of evidence in making healthcare decisions. This special theme issue includes research papers and commentaries by several of our awardees and others involved in our work.” Click here to view the blog post.
9. LAN Consumer and Patient Affinity Group Principles
PIPC is proud to be a member of the Health Care Payment and Learning Action Network’s (LAN) Consumer and Patient Affinity Group (CPAG). The CPAG members were provided a rare opportunity to develop consensus-based consumer and patient principles to inform the work of the LAN and its many subgroups. A draft of the principles agreed to by the Leadership Committee of the CPAG are now available for comment. A list of the Leadership Committee members is available here. If you have comments, please share with firstname.lastname@example.org.