In This Week’s Issue:
- Libertarian Republic: Proposed Medicare Rule Would Use Metric Banned During Obamacare Death-Panel Debate, click here to view the article.
- New York Times: Proposal to Reduce Medicare Drug Payments Is Widely Criticized, click here to view the article.
- Putting Cost Ahead of Medical Outcomes, click here to view the article.
- Health Affairs Blog: Patient-Driven Research Will Lead To Better Health, click here to view the article.
- The New Era of Informed Consent: Getting to a Reasonable-Patient Standard Through Shared Decision Making, click here to view the article.
- PCORI Blog: Placing Arthritis Research in Patients' Hands, click here to view the blog post.
- Video: Dr James Whitfill on Engaging Physicians and Patients in ACOs, click here to view the video.
1. Libertarian Republic: Proposed Medicare Rule Would Use Metric Banned During Obamacare Death-Panel Debate
As detailed last week in Libertarian Republic, “A Centers for Medicare and Medicaid Services’ proposed rule would use a metric for rationing health care that was banned following the Obamacare death-panel debate. The controversial rule, which has a public comment period ending May 9, calls for changes to Medicare Part B’s drug payment model and would use reports incorporating data using quality-adjusted life year (QALYs), a tool used for rationing health care by measuring disease burden. The changes have received pushback from both sides of the political spectrum over its potential to limit to drug access for the elderly and physically disabled. The proposal’s second stage suggests testing alternative drug payments using indications-based pricing, which would look at the cost-effectiveness of the medications. The Institute for Clinical and Economic Review (ICER) often uses QALYs, which measures disease burden and quality of life, when working out its data on differences in drug costs.”
“Critics, including patient advocacy groups like the Partnership to Improve Patient Care (PIPC), say the rule allows Washington bureaucrats to use an algorithm that fails to take real-life consequences into account – like doctors being pushed toward the cheaper yet possibly less effective treatment option. In a recent piece for US News and World Report, former Democratic Congressman Dan Maffi –who supported Obamacare – said it would unravel the safeguards put in place by the Affordable Care Act and eventually lead to higher costs… Lawmakers in both chambers have recently called on the administration to withdraw the rule.” Click here to view the article.
2. New York Times: Proposal to Reduce Medicare Drug Payments Is Widely Criticized
In Sunday’s New York Times, Robert Pear writes about CMS’ oft criticized Part B drug payment proposal, which PIPC has critiqued for relying on “one-size-fits-all” methodologies to determine patient access to treatments. An Obama administration proposal to reduce Medicare payments for many prescription drugs has run into sharp bipartisan criticism, suggesting that it is easier to diagnose the problem of high prices than to solve it. Patients’ advocates have joined doctors and drug companies in warning that the federal plan could jeopardize access to important medications. Every member of the Senate Finance Committee — 14 Republicans and 12 Democrats — and more than 300 House members have expressed concern… Bari Talente, executive vice president of the National Multiple Sclerosis Society, said her group opposed the administration’s plan in its current form. The National Alliance on Mental Illness, an advocacy group for patients, said the proposal ‘could limit access to long-acting injectable antipsychotic medications’ used to treat schizophrenia and other disorders. In a letter to Medicare officials, Dr. Laurie H. Glimcher, dean of Weill Cornell Medical College in New York, said, ‘This experiment puts the care of patients at unnecessary risk.’” Click here to view the article.
3. Putting Cost Ahead of Medical Outcomes
Wayne Winegarden, a Senior Fellow in Business and Economics at the Pacific Research Institute, writes about the challenges of implementing policies advanced by the Institute for Clinical and Economic Review (ICER). “Centrally planning the pricing decisions and best practices for any industry is an impossible task, but the consequences are particularly troubling for innovative industries such as health care. The problems of the National Institute for Health and Care Excellence in the U.K. exemplify the problem, and are a cautionary tale for ICER, which is taking methodology cues from NICE. NICE is the public body that establishes health guidelines and assesses the value of new medical treatments for the National Health Service, Britain’s government-run health care system used by 90 percent of Britons.
The recommendations from NICE have become increasingly controversial as critics claim that NICE guidelines are becoming more and more detached from the actual practice of health care. Patients groups also oppose the body’s rationing practices. According to the Independent, one woman awaiting a transplant for a rare condition that has destroyed her kidneys had her operation canceled at the 11th hour because the government refused to pay for the drug she needs to prevent the organ being rejected.’ Both NICE and ICER methodologies also rely heavily on ‘Quality Adjusted Life Years.’ QALY is supposed to be a benchmark for allocating scarce health care resources. According to the QALY methodology, expenditures that increase quality adjusted life years more should be prioritized.” Click here to view the article.
4. Health Affairs Blog: Patient-Driven Research Will Lead To Better Health
PCORI Board Chairman Grayson Norquist recently commented in Health Affairs Blog that “while putting patients' concerns front and center in research is fairly new, the work of [PCORI] ensures this focus is increasing and will continue to be a critical component of health care research in the future...We're helping to create a research culture that prioritizes patients' input by funding studies that incorporate their perspectives in a meaningful way. When engaged, patients, especially those with chronic or life-threatening conditions, have become enthusiastic research partners.” Click here to view the article.
5. The New Era of Informed Consent: Getting to a Reasonable-Patient Standard Through Shared Decision Making
As detailed in a recent JAMA article, “In the United States, approximately half of the states have adopted the reasonable-patient standard. The reasonable-patient standard views the informed consent communication process from the patient’s perspective. It requires physicians and other health care practitioners to disclose all relevant information about the risks, benefits, and alternatives of a proposed treatment that an objective patient would find material in making an intelligent decision as to whether to agree to the proposed procedure. Even in those states that apply the reasonable-patient standard, however, the informed consent process is often ill-configured to meet patients’ informational needs.” Click here to view the article.
6. PCORI Blog: Placing Arthritis Research in Patients' Hands
To mark Arthritis Awareness Month, Ben Nowell and Kelly Clayton shared their thoughts with PCORI about the Arthritis Partnership with Comparative Effectiveness Researchers (nicknamed ArthritisPower, or AR-PoWER). This partnership was created by CreakyJoints with researchers at the University of Alabama at Birmingham. Nowell is the Director of Patient-Centered Research at CreakyJoints, and Clayton is chair of the ArthritisPower Patient Governor Group. Click here to view the blog post.
7. Video: Dr James Whitfill on Engaging Physicians and Patients in ACOs
In a video for The American Journal of Managed Care, James Whitfill, MD, chief medical officer of Scottsdale Health Partners suggests that accountable care organizations have to work more on engaging physicians in meaningful leadership roles and should focus on learning about patient goals. Click here to view the video (2 minutes).
