The fiscal 2017 appropriations wrap-up package approved by Congress in early May included a $2 billion increase for the National Institutes of Health, despite a Trump administration request for a $1.2 billion reduction for the nation’s primary medical research facility. That bipartisan action, which funds the federal government through September, came in the face of President Trump’s demand to slash spending for domestic programs to pay for a huge increase in appropriations for defense.
Bob GattyThe fiscal 2017 appropriations wrap-up package approved by Congress in early May included a $2 billion increase for the National Institutes of Health, despite a Trump administration request for a $1.2 billion reduction for the nation’s primary medical research facility.
That bipartisan action, which funds the federal government through September, came in the face of President Trump’s demand to slash spending for domestic programs to pay for a huge increase in appropriations for defense.
Nevertheless, Republican appropriators in Congress were not swayed by the administration’s demand and thus replicated last year’s $2 billion increase for NIH. Rep. Tom Cole (R-OK), chairman of the House Appropriations subcommittee responsible for NIH, said he was proud of the fact that Congress doubled the NIH budget from 1998 to 2003 and increased it again in the 21st Century Cures Act, passed last year with broad bipartisan support.
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Rep. Nita M. Lowey (D-NY), the senior Democrat on the House Appropriations Committee, warned that Trump’s proposed NIH cuts would have “catastrophic results” for patients and researchers.
Congress’ refusal to accede to the White House NIH budget reduction for FY 2017 was applauded by one of the nation’s leaders in urologic research, Neal Shore, MD, current president of LUGPA.
“As a physician, president of LUGPA, secretary-treasurer of the Society of Urologic Oncology Clinical Trials Consortium, and as an educator who has run many advanced prostate cancer programs for the American Urological Association, it would be a huge mistake on the part of the federal government to diminish research funding in both the National Cancer Institute and NIH,” Dr. Shore, who is also medical director of the Carolina Urologic Research Center, told Urology Times.
While he welcomed the congressional action on the 2017 NIH budget, Dr. Shore is concerned about threatened cuts next year. The administration has asked Congress to provide NIH a total of $25.9 billion for FY 2018, which begins Oct. 1-a reduction of $5.8 billion, or 18% from the agency’s 2016 level of $31.7 billion.
“By taking $6 billion from the NIH in 2018 (and funneling that money into the Department of Defense, supposedly to fight ISIS), the Trump administration would set the agency’s budget back 15 years, below its 2003 level,” wrote Michael White, PhD, of Washington University in St. Louis, in an article published by Pacific Standard. “Such a drastic cut would not just reduce the amount of science done by U.S. scientists-it would harm our scientific workforce and infrastructure in ways that would take years, if not decades, to recover from.”
That is a primary concern of Dr. Shore.
“Providing appropriate funding for medical research is really important,” he said. “I feel very passionate about it. If we keep gutting our financial support for the best and brightest minds who have the desire and the DNA to be researchers, what is that going to do to our medical centers, our university research programs, and what will be the impact on everybody in the world who looks to us for a solution?”
Dr. Shore pointed out that “over the last 10 years, the amount of funding that has gone into urologic oncologic care and research has been plateaued, if not decreased. Now to slash it even more would not only be bad for global development of science, but would be particularly harmful to the U.S.’s position and standing as the leader in scientific research and development.
“As a urologic oncologist and someone who’s dedicated his career for the last 20 years doing advanced cancer research in urology, I’ve witnessed incredible breakthroughs in basic science and clinical transitional research that have helped men and women with urologic diseases live many years longer, often resulting in a cure of their disease.
“None would have been possible without the exceptional talent of researchers in urology at the National Cancer Institute (NCI) and NIH. NCI and NIH have been remarkable in their achievements, and the U.S. for the last 60 to 70 years has been at the forefront of clinical science research.”
But, Dr. Shore said, if sufficient support is not provided for NIH research grants, “the brightest minds in our country and from throughout the world will seek funding and support elsewhere.”
In his article, Dr. White cited an analysis by the American Society for Biochemistry and Molecular Biology that estimated Trump’s budget could force NIH to reduce funding for new research grant proposals by “a jaw dropping 88%” in 2018. Currently, he said, NIH awards between 9,000 and 10,000 new proposals each year, but the proposed cut could result in worst-case scenario of funding of just 1,200 new proposals in 2018, which would cause “lasting damage to U.S. science.”
While support for medical research is a major concern for Dr. Shore, he noted that physicians must deal with the reality of how they are paid for their services to Medicare beneficiaries. Thus, in April, LUGPA announced a new urology-specific Alternative Payment Model (APM) for newly diagnosed, localized prostate cancer.
Developed by LUGPA under the Medicare Access and CHIP Reauthorization Act of 2015, which ended the sustainable growth rate formula for Medicare reimbursement, the new APM would make it possible for urologists to be reimbursed based on the value, rather than the quantity, of services provided.
“There is a recognition that historically we have over-treated many patients who may benefit from active surveillance as opposed to active intervention therapy, such as surgery,” Dr. Shore said. “Assuredly, there are many patients who should have active intervention therapy, but we need to do a better job of encouraging the physician in a value-based model so we can get a management fee to provide the right treatment to the right patient at the right time.
“Under our model, there would be better health care provided to patients throughout the country as well as cost savings to the entire health care system. There are provisions to assure high quality is accomplished. There is a monthly fee to help encourage the most appropriate resource utilization of treatment. All advanced alternative payment models are predicated on high-quality patient-physician shared decision-making.”
The new LUGPA APM is to be submitted to the Physician-Focused Payment Model Technical Advisory Committee, which advises the Secretary of Health and Human Services on such proposals. The approval process is complex and could take some time before it is completed, Dr. Shore said.
“But LUGPA believes that this model will optimize outcomes, increase patient satisfaction and reduce utilization of unnecessary services, while simultaneously decreasing health care costs,” he said.
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