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March 05, 2016

ASCO, COA Unhappy With Proposed CMS Part B Reimbursement Model

Surabhi Dangi-Garimella, PhD
Several healthcare organizations have sent a letter to HHS urging withdrawal of this reimbursement model.

Reacting to the value-based reimbursement model proposed by CMS earlier today, the American Society of Clinical Oncology (ASCO) has said that “it is inappropriate for CMS to manipulate choice of treatment for cancer patients using heavy-handed reimbursement techniques.”

Urging CMS to reconsider their proposal, ASCO went as far as to say that the drug pricing problem should not rest on the back of physicians. The organization has begun its work to provide detailed comments to CMS on this reform proposal.

The Community Oncology Alliance (COA) too has come out against the new model. “The COA Board of Directors has voted to take a very tough stance against this CMS Part B experiment and we will fight it using every means at our disposal, including actively pursuing legal, legislative, and related options,” said a statement released by COA.

Early last week COA and ASCO in collaboration with about a 100 other provider and patient advocate communities, sent a letter to Sylvia Mathews Burwell, secretary, HHS, asserting that the average sales price or ASP should not be used to manipulate provider behavior. The letter states that the initiative focuses on costs of care based on zip codes rather than the unique challenges of each patient, and is misguided and ill-considered. The letter urges CMS to withdraw the proposed payment model.

“It is an understatement to say that this latest CMS initiative is misguided and a perilous cancer care policy,” said Ted Okon, executive director of COA, in a statement. “It will only serve to accelerate the consolidation of cancer care into the more expensive hospital setting and undermine the physician-patient collaboration on the treatment of cancer. I thought we were at war on cancer, not cancer care.”

COA has sent another letter to secretary Burwell, on behalf of COA’s board of directors. “The CMS Medicare Part B Drug Payment Model is an inappropriate, potentially dangerous, and perverse experiment on the cancer care of seniors who are covered by Medicare,” the letter states, adding, “For the sake of all of our patients, we simply cannot let CMS proceed with the dangerous Medicare Part B Drug Payment Model, which is not a true “model” in the CCMI legislative charter but simply another disguised cut to Medicare Part B reimbursement for cancer care. It is very revealing that CMS did not engage any patient and provider stakeholders in developing this perverse experiment, but is now seeking comment at the 11th hour in a “proposed rule”.”


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