Oncologist Rants at CMS Doc, and Meeting Audience Cheers

Nick Mulcahy

March 27, 2018

ORLANDO, Florida — At a medical conference, a Pennsylvania oncologist vociferously confronted a physician administrator from the Centers for Medicaid & Medicare Services (CMS) and said the agency is threatening his profession's livelihood and needs to change.

The incident was a rare public showing of anger, frustration, and even yelling among medical professionals. It took place here at the National Comprehensive Cancer Network (NCCN) 23rd Annual Conference.

Rodney Jamil, MD, of University of Pittsburgh Medical Center (UPMC) Pinnacle, in Harrisburg, Pennsylvania, was in the audience at the meeting and addressed Ron Kline, MD, of CMS's patient care models group. Kline was participating in a meeting roundtable discussion on value-based cancer care.

Speaking from the meeting floor, Jamil talked for roughly a minute and concluded by venting about the high cost of cancer drugs.

"It's the American taxpayer who subsidizes your institution and pays your salary, and you turn around and you want to rip [off] the taxpayer who subsidizes your organization, so why can't you get your act together and be a capitalist and negotiate drug prices with the pharmaceutical companies!" he fumed.

Immediately, cheers, whistles, and applause erupted from the audience, which included many oncology professionals.

Over the din, Kline responded: "I'm not the Congress, I'm not the Senate."

This was a reference to the fact that CMS is prohibited by Congressional mandate from negotiating with pharmaceutical companies. In effect, the drug companies name their price, and the government (and other payers who follow its lead) meet it. That arrangement is an oddity among industrialized nations — in other nations, governments negotiate drug prices with companies.

Yelling loudly, roundtable moderator Cliff Goodman of the Lewin Group, a healthcare consulting group, defended Kline: "He's not the Speaker of the House, he can't help you."

Notably, the audience had been told about 30 minutes earlier by another presenter, Lee Newcomer, MD, who is a former healthcare insurance executive, that CMS is not allowed to negotiate cancer drug prices. In an extended explanation, Newcomer detailed the legislative history of why CMS does not do so, making it clear that he believes that the CMS is blameless.

When things quieted down, roundtable participant Bhuvana Sagar, MD, national medical director, Cigna Healthcare, briefly addressed Jamil: "You have the right to vote." The suggestion was that only elected representatives have the power to change the way CMS pays for drugs.

Before the roundtable conversation, which is a staple of the NCCN annual meeting, tension in the audience was building.

At a number of points, applause exceeded the polite clapping that is usual at medical meetings.

Immediately before the roundtable ruckus, there were two presentations, including one by Kline entitled, "Transforming Cancer Care in America." He discussed the CMS' pilot program, the Oncology Care Model, which he directs. The model is an experimental Medicare payment and services arrangement underway at about 200 clinical practices of varying sizes in the United States.

One meeting attendee, who declined to be named, told Medscape Medical News that he and other colleagues are convinced that the Oncology Care Model — in some iteration — will eventually become standard in the United States.

Kline, who was formerly a private oncology practitioner in Las Vegas, Nevada, was appreciative of oncologists' efforts and acknowledged that working with government programs is challenging. "We are listening to you," he said.

Kline was repeatedly blunt about sensitive topics.

With regard to cancer care, he said that CMS has the goal of improved quality of care — at the same or lower cost.

Kline reviewed bullet points on the hallmarks of care, which are part of the Oncology Care Model. Among the difficult tasks that were included was estimating patients' out-of-pocket costs. Kline said: "[These] are things that a good oncologist should be doing anyway."

A physician at the meeting, whose practice is part of the pilot Oncology Care Model, praised it. "Ron's program has really changed the way we take care of patients," Michael Neuss, MD, of the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, said appreciatively.

Kline also told the audience about performance-based payment in the Oncology Care Model. These payments are based on a practice's achievement of quality measures and on reductions in Medicare expenditures below a target price. They are a semiannual bonus on top of monthly payments. In short, the NCCN audience heard about a lot of experimental changes in the always touchy and tension-filled topic of reimbursement.

National Comprehensive Cancer Network (NCCN) 23rd Annual Conference. Presented March 23, 2018

Editor's note: Dr Kline was mistakenly identified as Dr Fine in an earlier version of this story.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick.

For more from Medscape Oncology, follow us on Twitter: @MedscapeOnc.

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