Newtown, CT – December 23, 2016
A lump of coal and a nugget of gold, that’s what CMS distributed for Christmas – The nugget of gold went to pharmaceutical companies and others who would have seen some of the warped incentives with which they are currently being rewarded curtailed a bit, but whose incessant whining caused CMS to backtrack and abandon the planned changes. The lump of coal went to hospitals and physicians who saw their collective thoughtful comments on the proposed mandatory cardiac bundle ignored. And that lump was also dropped into the newly nominated HHS Secretary’s stocking. Representative Price and 100 of his colleagues had written a comment letter to CMS asking for the mandatory cardiac bundle to be abandoned, but apparently unphased by the request or the fact that Dr. Price will be leading the department that includes CMS, Andy Slavitt decided it was a good idea to go ahead and publish the final rule. At close to 1800 pages, it’s jam-packed with rebuttals of pretty much every recommendation to improve the proposal, including ours. Once again, the special interests win and the people lose.
What this means to you – The pilot of Medicare Part B changes was really important because they would have helped better understand the nature of the incentives created by the current pricing structure for some medications. And Pharma was sufficiently concerned that it would show them up badly that they went all out to block it. It is truly disheartening to see they succeeded, emboldening all the special interests at the expense of everyone else – those who pay the bills. Conversely, the mandatory cardiac bundles are completely unnecessary and very poorly designed, so much so that there is real legitimate concern that some of the incentives they would create could shift procedures done in outpatient facilities to inpatient facilities, increase the number of hospitalizations for AMIs that could be treated outpatient, and completely fail to put the focus of care where it should be, in the management of the underlying condition. MedPAC was against it, the HCPLAN’s recommendations contradict it, the entire physician caucus in Congress said not to do it, thousands of physicians and hospitals asked for a postponement, but apparently none of that matters because none of these people has Pharma’s clout. Of course, come the end of January, we’re hoping that then Secretary Price will take the lump of coal and throw it in the fire pit so that those who have been left out in the cold will get some welcomed warmth. In the interim, put these trials and tribulations aside for a week or so, and enjoy the needed rejoicing of Christmas and Hanukkah, for when the light shines, darkness retreats. Peace.