1. Roll Call: PIPC Chairman Coelho on Patient-Centeredness, Comparative Effectiveness, and Value, click here to view the op-ed.
2. PIPC Executive Director to Present on LAN Panel on Patient-Centeredness, click here to register for the event.
3. CMS Extends Deadline for Comments on MACRA, Alternative Payment Models, see details below.
4. The Hill: Cuts to Key Healthcare Agencies are Bad Medicine, click here to view the op-ed.
5. Transforming Research by Partnering With Patients - A View from the Field, click here to view the blog post.
As PIPC Chairman Tony Coelho commented in a Roll Call op-ed last week: “After five years of progress towards patient-centered comparative effectiveness research (CER), the Center for American Progress (CAP) threatens to unwind it by reviving the old debate over using CER to control medical spending. Proposals for Medicare and private payers to use CER are understandable, but concerning. Understandable because the challenge of rising costs is real, and policy-makers naturally reach for familiar policy tools. Concerning because it would pull CER away from individualized patient decisions and back towards centralized payer decisions. The end result would be limited choice of treatments based on one-size-fits-all determinations of ‘value’ for the average patient.”
“Policymakers talk about the ‘value’ of treatments as if there is one value algorithm that applies to all patients equally. While that may be true in academia, in the real world value is personal. Research on treatment value requires asking questions and measuring outcomes that matter to patients, and delivering care in ways that empower patients to make decisions based on their individual circumstances, needs and treatment goals.
“While CAP is seeking to address an important issue – affordability – its proposals to focus CER on payer needs would have serious, negative consequences for patients. First, it relies on methods such as those used by the Institute for Clinical and Economic Review (ICER), which uses cost-effectiveness standards and payer-focused budgeting as the basis for making average determinations about the value of treatments. Far from an independent, patient-centered approach, ICER’s model represents a non-transparent process with little or no patient input or review of its potential impact on care. Second, it threatens to refocus the work of the Patient-Centered Outcomes Research Institute (PCORI) to make national payment policy recommendations based on average value assessments. Yet, no patient is average.
“Congress recognized this fact when it created PCORI, determining rightly that CER should inform patient decisions, not limit patient choice. Congress agreed with the Partnership to Improve Patient Care (PIPC), as well as many other stakeholders and the American public, that instead of funding government research to strictly answer payer policy needs, the new institute should conduct patient-centered outcomes research that prioritizes questions from patients and measures outcomes that matter to patients so the information supports better – and more personal – decisions.
“PIPC’s recent public survey underscores the popularity, and importance, of keeping PCORI true to its mission and keeping CER focused on the patient. A strong majority of survey respondents (62 percent) continued to express support for an institute that conducts CER and that studies delivery systems as long as results are used to support and empower patient decision-making. Most respondents (69 percent) also said that research should only be used to give doctors and patients more information about which options are right for individual patients.
“At the same time, respondents expressed opposition to using CER results in ways that restrict access or limit treatment choices. Most of those polled (72 percent) opposed allowing Medicare to compare the efficacy of treatment options, and upon deeming them similarly effective, only covering the less-expensive option.
“The good news is that we are building a strong infrastructure for prioritizing the patient experience and perspective. PCORI emphasizes patient engagement in the prioritization and conduct of CER, empowering patients and caregivers with information, not misusing it to restrict access and choice. The Food and Drug Administration (FDA) increasingly incorporates patient perspectives into its regulatory processes through the Patient-Focused Drug Development program.
“So we again face a choice. Will we continue conduct CER to support patient needs and the science of personalized and “precision” medicine, or are we going back to the paternalistic days of patting patients on the head, telling them to take two pills and call back in the morning. I cannot imagine patients want to be sidelined in their own care decisions based on centralized value assessments from CER studies that are meaningless to them personally. We’ve come too far in building the research and innovation infrastructure that enables personalized decisions to throw it all away because we do not systematically believe patients should be driving their own care. As PIPC’s Chairman and a patient with a disability myself, I would urge policymakers to move forward – not backward – and to embrace the ideals of patient-centered, personalized medicine.”
2. PIPC Executive Director to Present on LAN Panel on Patient-Centeredness
The Health Care Payment Learning and Action Network (LAN) will hold a summit on Monday, October 26, in which PIPC Executive Director Sara van Geertruyden will present on a panel entitled Building a Patient-Centered Health System. This session will be moderated by LAN Guiding Committee Member, Alan Balch of Patient Advocate Foundation, and is scheduled to take place in Salon V from 10:15 to 11:30 am. According to the LAN, “whether your organization is just beginning to explore APMs or has been running a high quality, high value payment model for years, this event will support you as you Engage, Learn, and Act!” Click here to register for the event.
3. CMS Extends Deadline for Comments on MACRA, Alternative Payment Models
The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for comments on the recently-released a Request for Information on the physician payment reform provisions within the Medicare Access and CHIP Reauthorization Act (MACRA). The April 2015 law repeals the Sustainable Growth Rate (SGR) formula, replaces it with a multi-year phase-in of new physician incentives and updates and requires that CMS consult with stakeholders on implementation. CMS notes that feedback on this RFI as well as the proposed calendar year 2016 Medicare Physician Fee Schedule rule will inform its eventual proposed policies. Comments are now due by November 17 (rather than Nov. 2). CMS officials describe the MACRA reforms—including the Merit-Based Incentive Payment System (MIPS), and Alternative Payment Models (APMs)—in a Health Affairs blog post here.
4. The Hill: Cuts to Key Healthcare Agencies are Bad Medicine
As Dr. Rainu Kaushal of Weill Cornell Medicine commented in The Hill last week, “with Congress racing to complete legislative work, lawmakers should ring the alarm bell and reverse severe budget cuts for two organizations essential to the U.S. healthcare system. The Agency for Healthcare Research and Quality (AHRQ) and the Patient Centered Outcomes Research Institute (PCORI) may not be well known to the average American, but the proposed draconian cuts to their budgets will be felt in examination rooms and wallets all around the country. AHRQ provides independent analysis to make healthcare more affordable and accessible, while PCORI provides invaluable research on the comparative benefits of medical treatments to empower patients and their doctors to make better choices. Yet in June the House Appropriations Committee voted to eliminate all funding for AHRQ, redirecting the funds to the National Institutes of Health (NIH). The panel also proposed to cut PCORI’s funding by $100 million. A Senate proposal would cut AHRQ’s $364 million budget by 35 percent.
“Supporters of the proposed cuts argue that the missions of the two organizations overlap with one another and with those of NIH. But this is an inaccurate view and one that ignores the mandate and value of the three organizations, all of which are needed to deliver the best healthcare possible… PCORI’s mission is very different and largely patient focused. The remit of this federally funded non-profit organization is the funding of comparative effectiveness research, which focuses on the effectiveness of any given treatment or preventative recommendation. It provides the essential information physicians and patients need when making treatment decisions…. AHRQ’s primary mission is complimentary, and not duplicative, of either NIH or PCORI. A division of the Department of Health and Human Services, AHRQ provides health services research. This includes detailed analysis of current and emerging models of healthcare, the cost and financing of healthcare, access to healthcare services, and the quality and safety of our healthcare system… Advances in medical care are arriving at an extraordinary rate. If physicians and patients are to navigate the growing panoply of treatments and if Americans are to have access to affordable healthcare, we need AHRQ and PCORI in place, fully funded.” Click here to view the op-ed.
5. Transforming Research by Partnering With Patients - A View from the Field
In a post on The PCORI Blog last week, Bray Patrick-Lake, Duke University’s Director of Stakeholder Engagement, comments “We are at a tipping point. The research system is changing. I want to be sure that patients have a voice in building the research system we want. We need timely access to data and understand that there's a lot of complexity to that. Sometimes change seems incremental, but in the end we can achieve transformation. Only when we abandon inefficient practices and recognize all stakeholders as equal partners will we achieve a truly innovative system of rapid research.” Click here to view the blog post.