The Shadow Organization that Calculates When You Are Too Old to Waste Money On

October 21st, 2016

This is the third installment of a four-part series on shadow organizations that effect your healthcare.  The first week I talked about the Centers for Medicare & Medicaid Innovation (CMMI), last week I talked about the Medicare Payment Advisory Commission (MedPac).  This week I’m going to talk about the Institute for Clinical and Economic Review (ICER).

ICER started as a project at Harvard Medical School in 2006 but didn’t become an independent non-profit until 2013.  This is when their focus shifted toward calculating ways to cut costs for insurance companies rather than what is best for the patients.  They have come under so much fire from all quadrants for their questionable conclusions about how they assign value to medicines that one of the four main selections on their web site’s home page is titled, “Addressing Misconceptions About Our Work”.  For me that raises a red flag.

One of the “misconceptions” they reference is that they are controlled by the insurance industry.  They say that it isn’t true but three out of four of their senior managers have deep roots in the insurance industry and six out of ten of the people on their governance board either work for, or have roots back to, insurance companies.  Most importantly, their cost evaluations favor reducing costs for insurance companies.

A second item where they said they were misunderstood was that “ICER does not engage meaningfully with patient groups during the development of its reports”.  They go to great lengths to describe how they include stakeholders in their work, yet one incident reveals their true nature.  The Multiple Myeloma Research Foundation (MMRF) felt it was necessary to write to ICER to deny ICER’s claim that the MMRF was a stakeholder on a cancer report they released last April.  Specifically, the MMRF said;

In the Draft Report, the MMRF is cited as a “Stakeholder” by ICER; this may be misconstrued and requires clarification. . . To be clear: the MMRF has not contributed to and in no way endorses, supports, or affirms the views reflected in the ICER Draft Report.”

It is revealing that ICER is so disconnected from the stakeholders that a letter like this is necessary.  You can click here to read MMRF’s entire letter, and those of other stakeholders, to see the total lack of connection ICER has with these groups.

Another “misconception” cited was that ICER ignores the patient perspective in its approach to value assessment”. They again work to explain away this perception but the proof is in what they say and how they arrive at their conclusions concerning the value of healthcare.  The most egregious sin is ICER’s use of Quality Adjusted Life Year (QALY) in calculating patient value.  This is the same calculation used in Britain’s healthcare system to ration healthcare by denying care or medicine because a patient is too old or frail.  To me this is the definition of ignoring the patient perspective.

You may ask yourselves, why is this unknown organization called ICER important to me.  It’s important because the Centers for Medicare and Medicaid Services (CMS), the people in charge of Medicare, use ICER’s input to guide many of their decisions.  When CMS needs a report to back their reason for cutting payments, raising patient costs or limiting access they turn to ICER.  Just recently they used ICER’s calculations to support a demonstration project for cancer medication (I’ve talked about this project recently) that is really the roll out of a cut in Medicare payments that will hurt doctors and limit your access to medicine.  This project was based on ICER’s reports, an organization that uses QALY as its basis for calculating healthcare value, a method of healthcare rationing that we thought we had rejected here in America.

ICER is just another shadow organization that is out of sight and not controlled by Congress or the Judicial system yet has a huge influence on our healthcare.  RetireSafe is committed to fighting these type of organizations and to bring them out into the open.

Next week I’ll talk about our final shadow organization, the Independent Payment Advisory Board (IPAB).  You might remember it from our discussions during the Obamacare debates.  Raise your hand if you remember the “death panel”.  It has been in the shadows for over 5 years but, just as we predicted, it is getting ready to raise its ugly head.  Look for that email next Friday.



Thair Phillips – President