Physicians Have a Different Approach to Medicare Part B

The Trump administration recently signaled its interest in reforming the Medicare Part B program by “experimenting” with an international pricing index.

According to Health and Human Services Secretary Alex Azar, the aim is to drive more competition and negotiation into the decades-old program by potentially curtailing patient access to medications arbitrarily deemed too expensive. But if you ask physicians how they would approach a potential path forward for Part B, they would offer a far-less disruptive prescription.

The cornerstone of the American health care system and the broader Medicare program has always been patient choice. This elasticity gives individuals and their doctors the flexibility to choose the most effective treatment regimens best tailored to their needs. The Trump administration’s proposal would potentially limit these choices by instituting far-reaching, mandatory participation in a “coverage experiment” or demo that would tie providers to a rigid one-size-fits-all list of available medicines.

This approach is more akin to the Obama administration’s pattern of overreach in its attempted Part B reforms through the Center for Medicare and Medicaid Innovation than what you would expect from a conservative administration. In fact, the Trump administration is proposing to utilize the very same CMMI model “experiments” to institute this index, despite ample evidence that such mandatory demonstrations are overbroad and disruptive to beneficiaries’ care.

For many seniors, these abrupt changes undermined the peace of mind Part B coverage offers. This erosion of trust in coverage has been shown to correlate with negative effects on overall patient adherence to treatment regimens, leading to worse health outcomes and higher health care costs in the process.

Beyond the very real potential for a bureaucratic and regulatory nightmare, for providers, this proposal represents something more acute. Medical societies from a diverse range of specialties have weighed in on the proposal, imploring the Trump administration to take a different approach that does not jeopardize patient access to care they need.

Many of these providers treat patients with complex illnesses, such as cancer, who rely on a diverse set of often innovative drugs to live. Indexing these drugs in such a way may further constrict care options by closing practices, particularly in rural, underserved and low-income areas where patients already struggle.       

Previous administrations have attempted to reform the Part B program, with varying successes in the past. The Bush administration, through the Medicare Modernization Act of 2003, changed Part B reimbursements to reflect private sector competition, reducing Medicare costs in the process. Or, speaking as a former practicing surgeon, they took a scalpel to the problem areas of Part B without destroying the parts that work.

Fundamentally, if President Donald Trump and his allies hope to deliver meaningful results for the approximately 56.8 million Part B beneficiaries, they must ensure that any reforms to Part B are thoughtful, rooted in medical science and take into account the needs of patients.

Over and over again, you’ll hear the saying “if it ain’t broke, don’t fix it” related to government programs. But while Medicare Part B certainly works for patients and physicians alike, it is by no means perfect.

We should never settle for a health care system that merely “works” but strive for one that consistently delivers exceptional care. By looking outside government to successful ideas in the private sector and ensuring that any reforms to Medicare Part B are grounded in patient choice, the Trump administration can make that vision a reality.


Dr. Charles Boustany Jr. is a prominent heart surgeon and former congressman (R-La.) who served on the House Committee on Ways and Means.

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