May 24: COA Submits Formal Comments on CMS Medicare Part B “Model”

It is an Experiment that is Bad Medicine, Flawed Economics, Destructive Policy, and Legally Invalid

The Community Oncology Alliance (COA) today submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) regarding the proposed Medicare Part B Drug Payment Model. The letter expresses strong opposition to the CMS experiment and requests that it be withdrawn. It provides a detailed explanation, backed by data, on why the experiment is bad medicine, flawed economics, and destructive policy, with dire constitutional implications. COA is committed to stopping this hastily developed and ill-conceived CMS initiative, even if that requires legal action.

“This proposal is anything but a test of a payment model, as CMS purports,” said Bruce Gould, MD, president of COA and medical director of Northwest Georgia Oncology Centers in Marietta, Ga. “Colleagues at COA and I have been working with CMMI

[the Centers for Medicare & Medicaid Innovation] for close to 3 years on the development of a real oncology payment model. And in the blink of an eye, without any stakeholder input, CMS comes up with a dangerous experiment on seniors – one we simply will not let them implement.

In the comment letter, COA explains how the CMS “test” is just that—an experiment to change oncologists’ clinical decision-making, with test and control groups randomizing patients by where they are treated.  Yet, unlike ethical health experiments, patients cannot opt out, there is no “informed consent,” and CMS has failed to build in real-time monitoring of quality outcomes or adverse events.

“It’s alarming to think that some government bureaucrats, who have never practiced medicine, are telling me, a Board-certified oncologist with 18-years of experience, that I’m not treating my patients appropriately,” said Jeffrey Vacirca, MD, vice president of COA and CEO of NSHOA Cancer Center in East Setauket, N.Y. “My patients come first – always come first – and I spend a lot of time personalizing their care and treatment. What the government wants to do is come between me and my patients, forcing cookie-cutter medicine that they think is right.”

Included in the COA letter is a detailed analysis of how standard-of-care cancer drugs are severely impacted by CMS’ ill-conceived experiment. The letter also includes an expert review of the Memorial Sloan Cancer Center’s recent report that incorrectly contends oncologists have choices to use less expensive cancer therapies. Unless patient care and outcomes are to be sacrificed that is simply not the case.

COA oncologists and practice administrators have met with officials from CMS and CMMI to present findings from a recently-released Milliman study on the cost drivers of cancer care and discuss their concerns with the experiment. The study results, referenced in the COA comment letter, show how CMS’ ongoing, decade-long experiment to ratchet down reimbursement for cancer care that has only driven up Medicare spending and drug prices. CMS cuts, coupled with the runaway 340B program, have also had the unintended consequence of driving cancer care into the much more expensive hospital setting.

“If you see a fire you don’t pour gasoline on it to put it out. That’s exactly what CMS is doing with an amazingly misplaced attempt to address the costs of cancer care,” said Ted Okon, executive director of COA. “All CMS policy has done over the the last 12 years is balloon Medicare spending on cancer care. Now, they are going to add insult to injury, accelerating cancer care spending with a proposal that is not just another reimbursement cut but is also an assault on patient care and physician clinical decision-making.” 

Access the Full Formal Comment Letter from COA HERE.