Medicare Pays Doctors To Cut Treatment

SHEPHERDSTOWN, W.Va. - Feb. 12, 2014 - PRLog -- Medicare now pays 369 medical groups to reduce spending on their patients. Medicare gives each group half of any money it saves, so the groups have an incentive to reduce expensive care, such as chemotherapy, HIV therapies, or transplants.

Dr. Cary Presant, chair of the Medical Oncology Association of Southern California, said, "The unspoken word is 'try and find a way to get these patients to not utilize these drugs.'" Dr. Roger Macklis, a Cleveland Clinic cancer doctor writing with a Case Western researcher, said, "Oncologists may feel pressured to curb the use of costly drugs and expensive procedures."

The first complete list of the groups, by state, is at aco.globe1234.com. It includes 123 groups which started in January, and 246 older groups. There are now 47 groups in Florida, 35 in California, 28 in Texas, 26 in New York, 20 in Virginia, 20 in Massachusetts, 19 in Michigan, 18 in New Jersey, 18 in Illinois, and 17 in Georgia.

Medicare rewards these groups for giving their patients less treatment. Patients can accept the incentive for reduced care, or use another group. Patients who have other insurance can avoid the incentive and keep their doctors by dropping Medicare part B doctor coverage. They can also get second opinions from doctors outside the group.

Medicare says these "provisions have a substantial effect on reducing the growth rate of Medicare spending," and the groups "must meet quality standards." The quality standards omit most diseases, cancer care, HIV therapies, dialysis care, disability care, osteoporosis, pain and death rates. Care can decline in any of these areas without counting as a quality problem.

Some groups may be more interested in antitrust waivers than lower costs. Agreements among doctors and hospitals are exempt from antitrust if "the arrangement is reasonably related to the purposes of the Shared Savings Program... public disclosure shall not include the financial or economic terms of the arrangement" (Federal Register 11/2/2011 p. 68001).

These "Accountable Care Organizations" (ACOs) have been controversial since they started. A discussion in the Wall Street Journal Jan. 23, 2012 quoted a former Medicare administrator, Tom Scully, saying ACOs would not work and would be dominated by locally powerful hospitals forming ACOs. "The biggest flaw with ACOs is that they are driving more power to hospitals—not to doctors. Very scary, and I am a hospital guy. The goal of ACOs was to organize doctors to focus more on patients and keep the patients out of hospitals. Instead, doctors are selling practices to hospitals in droves."

The editor of aco.globe1234.com, which lists the groups and the quality standards, is Paul Burke, a retired federal researcher. A graduate of Brown University, he has managed and analyzed data for HUD, Congress' Office of Technology Assessment, and the UN Development Programme, and now edits Globe1234 as a watchdog site.