Nobody said reforming Medicare was going to be easy, and the backlash to the Obama administration's proposed changes about the way doctors are paid by the massive entitlement program shows why.
Loud critics, such as doctors and patient advocacy groups, have emerged in response to the administration's attempted reform of Medicare Part B, the part that covers outpatient services, including treatment for serious conditions at specialty clinics.
Oncologists and others who administer expensive drugs to patients through Medicare are worried that a new payment model the administration has floated will cut into their margins or even make their practices financially nonviable.
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Currently, doctors are reimbursed for administering a drug by the average sales price of the medication plus 6 percent. The Centers for Medicare and Medicaid Services has proposed reducing the add-on to 2.5 percent along with a flat fee of $16.80 per day. The idea driving the policy is that the high percentage add-on is an incentive for doctors to choose more expensive drugs.
Influential groups have lashed out. Drug makers obviously aren't happy about a federal policy that encourages doctors to avoid high price products, while patient advocates say that the seniors' health could be on the line.
"I remain highly concerned that CMS's proposal uses a cookie-cutter approach that fails to recognize the individual patient needs of America's diverse Medicare population," wrote Rose Gerber, director of patient advocacy and education at the Community Oncology Alliance, in a recent column for Morning Consult.
An anonymous source told The Hill that the administration was caught off guard by the backlash. Indeed, Patrick Conway, the head of CMS, suggested as much to the political magazine.
"We thought we expressed this well in the proposal, but we've heard from some patient groups, so I want to say this clearly: We hear you, and we will deeply engage patient and consumer communities in this model," he said.
Still, the administration has powerful allies in its corner, including AARP, which apparently judges the long-term fiscal health of Medicare to be important enough to back a policy that has providers and some retirees nervous.
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