Change is in the air for Floridians, who may have to deal with significant Medicare reform in the next few months. While updates in the past have only led to subtle changes in the state’s Medicare coverage – most of which were beneficial to citizens – a new major reform could reduce Florida senior citizens’ access to treatment for a host of serious medical problems, from cancer to arthritis. Florida citizens, especially the disabled and the elderly, need to be aware of these proposed changes to prepare for potential coverage pitfalls.
Medicare Reform in Florida
Recently, officials at the Center for Medicare & Medicaid Innovation (CMMI) announced a major system reform that could save the government billions of dollars. The reform is an experimental payment system for advanced drugs covered by Medicare Part B plans. These drugs combat rheumatoid arthritis, osteoporosis, autoimmune diseases, cancer, hemophilia, kidney failure, and a number of other complex conditions. The new payment system would impose steep pay cuts for half of all physicians in Medicare Part B – in theory, saving billions of dollars.
Currently, Medicare Part B reimburses physicians the average sales price of advanced medications plus an addition 4.3% for administering the drugs. The new payment system would reduce the administrative fee significantly, to 0.85%. It would also impose a flat fee of $16.80. CMMI believes the new system would discourage physicians from prescribing expensive medications. As a result, outpatient clinics and physicians who deal mostly in advanced drugs would have to shut their doors.
How the Reform Affects Patients
If the proposed reform takes place, many health care clinics in Florida will struggle to stay in business. Even under current drug reimbursement rules, dozens of cancer clinics in Florida closed down permanently. What the reform ultimately means is that while the state government would save billions of dollars in reimbursement costs, the sick, disabled, and elderly will have less access to life-saving medical facilities. Clinics and physicians Floridians have come to rely on for care and treatment may no longer be an option soon.
England, Sweden, and Canada have implemented similar reimbursement pay cuts for cancer medications. The outcomes have been bleak for cancer patients, who consequently suffered lower survival rates due to limited access to medications. If the U.S. implements CMMI’s plan and follows suit, Medicare users may suffer the same fate.
Even worse is that CMMI could potentially block patients from receiving the more advanced medical therapies at all. In early 2017, the second phase of the CMMI reimbursement cuts will take place – implementing a value-based pricing system. CMMI will study the cost and effectiveness of complex drugs and “advise” doctors to prescribe the most cost-effective option. This could mean the disappearance of certain drug choices and comprehensive condition treatment options from the shelves.
The immense cost savings the government will enjoy if CMMI’s proposed plan of action takes place next year means that CMMI administrators will likely proceed with the reimbursement cut plan. While the new plan would encourage quality over quantity of care, it would doubtlessly lead to smaller margins for clinics that are already barely getting by. The closure of dozens of clinics in Florida may leave Medicare patients in the lurch.
Many disabled Florida citizens are only able to return to work and enjoy a better quality of life with the help of certain drugs. Complex medications have revolutionized how doctors treat certain diseases, helping injured, sick, and terminal patients manage their conditions. Now, the CMMI’s new system may put these life-saving medicines just out of reach for Medicare patients. Unless patients speak out about this injustice, doctors may have to turn patients away or close their doors for good starting next year.