Becker's ASC Review

28 Thought Leadership (Continued from page 27) For gastroenterologists, our patients with Crohn's disease and ulcerative colitis will be hit hardest. Treatment for these diseases is enormously complex and the medications can be expensive, but they are badly needed for people who are suffering from abdominal pain, persistent diarrhea, intestinal bleeding, fever, weight loss and worse. On top of living with terrible symptoms, many of our patients face increasing cost-sharing burdens imposed by insurance companies and pharmacy benefit managers. As you can imagine, the coupon programs help patients continue with expensive treatments. [Patients recognize sig- nificant] savings. According to a recent Health Affairs study, patients can save between $50 and $100 a month. While the goal seems to be lowering Medicare expenses through a change in [average sales price], the bill could instead cause pharmaceutical companies to eliminate the coupons and patient assistance programs because of the overall effect on their margins. With no change in ASP pric- ing, Medicare won't save money, but the patients who need financial help the most will experience even higher costs. This could lead our patients to forsake needed treatments and experience more complications, which would thereby increase the cost of care in the long term. It could also make it harder for medical practices to provide certain medications in the convenience of our offices. Physi- cian practices are already confronting reduced reimburse- ment as a result of the budget sequestration of 2013. If the Medicare reimbursement rate falls because the value of coupons are included in calculating the ASP, the actual costs for some treatments may not be covered, which could cause physicians to no longer provide those treatments. This would be especially difficult for smaller practices and those in rural or underserved areas. Q: What sort of alternative options should Congress consider? MW: We share Congress' goal of ensuring the sustainability of the Medicare program, and recognize the leadership of the Senate Finance Committee in working to lower drug prices. We are generally supportive of the policies in the Prescription Drug Pricing Reduction Act that would reduce beneficiary out-of-pocket costs, improve access and price transparency, and increase market competition in the Medi- care program. We support the provision that caps out-of- pocket costs for seniors with very high costs. Patients should have access to safe and effective treatments at the lowest possible cost, and biosimilars can help to bring costs down. We appreciate that there is language in the bill that aims to improve patient access to treatments by supporting biosimilars. Our major concern about the bill is Section 102, because the changes it would implement to the ASP formula could result in increased out-of-pocket costs and make treatments less accessible. If physician practices can no longer afford to administer these drugs, this policy is likely to force patients to seek care in the more expensive and less convenient hos- pital setting, where Medicare and patients pay dramatically more for drug administration. Q: If Congress continues with this proposal, what could independent practices do to prepare? MW: It's important for GI physicians to be involved in policy advocacy. We have important insights to share about how these policies impact the lives of our patients. We need to participate and work to protect against changes that will negatively affect the patients for whom we care. On this specific proposal, there are many physician and patient advocacy groups that are working to educate our policymakers about the unintended consequences that the proposal will have on our patients. Were hopeful that we'll be able to work with the Senate Finance Committee to find policy solutions that will reduce costs for patients with Crohn's disease, ulcerative colitis, and other diseases and chronic conditions without weakening access to medi- cations that improve the quality of life for thousands of patients. n The future of cardiology in ASCs: Physicians Surgery Centers' Jeff Dottl weighs in By Rachel Popa J eff Dottl is a principal for Physi- cians Surgery Centers, a professional ASC management and development company. Recently, he was asked to join an ad hoc California Ambulatory Surgery Association committee addressing cardiol- ogy procedures in ASCs. Here, he shares his thoughts on the future of cardiology in ASCs. Note: Responses have been lightly edited for style and clarity. Question: What are the current opportunities to add cardi- ology procedures to ASCs? Jeff Dottl: ere are so many opportunities. But this is undiscovered territory for most interventional cardiologists. Lewis and Clark may have already paved a route to the Pacific Ocean, but it is still going to take a while before there is a freeway connecting the East and West coasts. In our centers, we have found that the highest level of physi- cian comfort is with cardiac rhythm management devices. Generator changes can be done safely and without much, if any, capital expendi- tures since good ASCs generally already have all the equipment needed for these procedures. Primary placement of these devices is also a big opportunity for ASCs and adds greatly to the universe of potential ASC patients. Other opportunities exist for vascular-related procedures, such as atherectomies, but physician willingness/comfort is generally the limiting factor here. (Continued on page 29)

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