Dr Barbara McAneny Discusses Concerns With New Medicare Policies

The American Medical Association (AMA) has concerns with the proposed changes CMS is looking to make to the Medicare accountable care organization (ACO) program and with the announced change to allow step therapy in Medicare Advantage plans, explained Barbara L. McAneny, MD, president of the AMA.

Transcript

How do you expect CMS’ proposed Pathways to Success program, which forces ACOs to take on downside risk after just 2 years, will impact new and existing ACOs?

The American Medical Association just sent a letter to CMS talking about our concerns about the rapid switch to downside risk. We have several concerns. The first of which is the ACOs who taking one-sided risk, where they are not at risk of having to pay Medicare back for missing the targets, they save more money than the ones that are taking 2-sided risk.

So, since the goal of the ACOs is to deliver better healthcare at a lower price, we think that switching from the group that’s more successful at that and forcing everyone into a model where it hasn’t performed as well, may be problematic.

CMS announced in August that Medicare Advantage plans can start to use step therapy, which is supposed to reduce healthcare costs. How does AMA view this change?

The AMA is disappointed with that change to allow Medicare Advantage plans to do a fail-first program. People often change their Medicare Advantage plans every year or 2 or plans change what they put as first-line drugs depending on the economics of what they purchase it for. That is incredibly disruptive for patients.

For cancer patients, if we have to have patients fail first on the old-fashioned, less-expensive chemotherapy before they can get to the stuff that’s going to make a difference in their life, we’re going to do damage to people.

This administration has wanted also to cut documentation requirements. And we applaud that. We are definitely in favor of cutting down the amount of documentation physicians have to do. But, if now I have to go through this process, every time I treat a patient on a Medicare Advantage plan, to plead with them to let me give the patient the drugs that I think are better, they have just increased my documentation and physician burnout risk significantly.

So, we would like to be able to work with the administration to find better ways to save money. We absolutely agree that we need to save money in this system. We understand that physicians need to be held accountable for the quality of the care that we deliver. We just think there are better ways to do it than the prior authorization process or the fail-first processes that are going into Medicare Advantage plans now.