PIPC Letter to MedPAC: Don’t Rely on Cost-Effectiveness to Make Coverage and Reimbursement Decisions
In a letter to the Medicare Payment Advisory Commission (MedPAC), Over 40 organizations representing patients, people with disabilities, and providers joined PIPC to express concerns about MedPAC’s consideration of cost effectiveness in Medicare. “We are concerned that the “incremental approach” suggested by commissioners may be intended to impose cost effectiveness over time, thereby avoiding intense scrutiny despite its methodological flaws and long-term impact on access to care. Additionally, such a policy recommendation would rely on overturning or undermining the law passed in 2010 by Congress banning Medicare from incorporating the QALY metric used in cost effectiveness analyses.
In response to a request for information from a bipartisan group of senators, PIPC has submitted comments on barriers to price and information transparency in health care. “When patients do not have access to information that allows them to assess the best available treatment for them, our health care system bears the cost of reduced treatment adherence, increased hospitalization and other acute care episodes, as well as the societal costs of increased disability over time. While insurers may see those costs in different buckets, patients do not. Your work could drive a more holistic perspective of healthcare centered on the patients and people with disabilities that are the ultimate beneficiaries of healthcare.”
In a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho criticized the HHS Notice of Benefit and Payment Parameters for focusing on cost effectiveness and creating a national default definition of essential health benefits. While the notice proposes flexibility for states in defining essential health benefits, Chairman Coelho noted that the Notice of Benefit does not focus on how to align payment with achieving care tailored to individual patients. "It fluctuates between a policy of “anything goes” by allowing states increased flexibility in defining their benefit packages, and a “one-size-fits-all” policy relying on cost effectiveness reports to determine patient access to care," wrote Chairman Coelho. "To truly put patients first, CMS should instead embrace this as an opportunity to change the culture of our payment system to be patient-centered."
In a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho submitted comments on behalf of PIPC in response to the Request for Information on a new direction to promote patient-centered care at the Center for Medicare and Medicaid Innovation (CMMI). Chairman Coelho urged CMS to implement "concrete reforms" in four key areas, including: (1) Defining a clear, consistent process for engaging patients and other stakeholders in development and implementation of CMMI evaluations; (2) Defining and adopting detailed criteria for patient-centeredness in CMMI evaluations; (3) Building on and strengthening the patient safeguards articulated in the RFI and; (4) Pursuing demonstrations that embody these reforms and put patients at the center of the health care.
In a letter to Department of Veterans Affairs Secretary David Shulkin, over 40 representatives of veterans, patients and people with disabilities expressed concern regarding the recently announced collaboration between the Institute for Clinical Economic Review (ICER) and the Department of Veterans Affairs (VA) Pharmacy Benefits Management Services office. They cautioned Secretary Shulkin about ICER's quality-adjusted-life-year (QALY) metric, citing its "potentially discriminatory" impact on people with disabilities and serious chronic conditions.
PIPC Submits Letter to HHS Expressing Concerns about MassHealth Section 1115 Demonstration Amendment Request.
In a letter to acting Health and Human Services Secretary Eric Hargan, Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho expresses serious concerns with the proposal in the Massachusetts 1115 waiver amendment that would potentially limit access to new and innovative drug therapies. Chairman Coelho suggests to Secretary Hargan that the State of Massachusetts look to entities such as PCORI for insights on how to measure comparative effectiveness of treatments in real world situations. "We encourage states like Massachusetts to invest in the development of shared decision-making tools that reflect how treatments impact patients in real-world circumstances, so that patients are able to choose the treatment that is most effective for their individual needs," wrote Chairman Coelho. "You have an opportunity to partner with patients and people with disabilities to determine the outcomes that matter most to them in their treatment, measure those outcomes, and translate that information into tools that ensure patients get the right care at the right time."
In a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho submitted comments on the proposed cancellation of the episode payment models. In the letter, Chairman Coelho applauded CMS for prioritizing provider participation in voluntary models. "I was pleased to learn that the Centers for Medicare and Medicaid Services proposed to cancel the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) incentive payment model and to rescind the regulations governing these models," wrote Chairman Coelho. "It is not because I do not think the agency should test new payment models. It is simply because, based on input from patients and providers, these models required more work to get it right, and certainly were not seen as sufficiently evaluated to be mandatory."
In a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho expressed his concerns about the latest proposal to the Medicare Shared Savings Program to remove the requirement to submit supporting documentation related to patient-centeredness in their applications. "We are concerned that CMS would propose to remove these requirements and accept attestation in their place," said Chairman Coelho. "Although we understand that CMS is attempting to lessen the burden on ACO applicants, we believe that it is imperative that ACOs be held to the highest possible standard for patient-centeredness."