Physician Group Opposes Proposed CMS Rule Regarding Antibiotic Use

The Association of American Physicians & Surgeons (AAPS) recently submitted critical comments to the US Centers for Medicare and Medicaid Services (CMS) regarding a proposal to regulate antibiotic use.

AAPS sent a letter to Acting Administrator of the CMS Andy Slavitt opposing the proposed rule (CMS-3295-P). The group states that the rule would subject Medicare beneficiaries to guidelines that are controlled by private organizations, such as the Infectious Disease Society of America (ISDA), according to the letter.

AAPS does not believe that a public program funded by taxpayers should comply with guidelines set by private organizations that may have conflicts of interest or a hidden agenda. Although the CMS references the ISDA multiple times in the proposal, they do not mention that the organization was under investigation by the State of Connecticut regarding conflicts of interests.

CMS guidelines allegedly benefited financial interests for insurance companies, according to AAPS. The settlement requires IDSA to create more stringent rules against conflicts of interest, but AAPS states that the organization continues to benefit insurance companies.

AAPS also said that private organizations should not be allowed to terminate antibiotic use in accordance with their guidelines, which the group stated were created to benefit insurance companies.

According to the letter, AAPS states that they oppose the following proposed regulations:

• (42 CFR chapter IV) § 485.640(b)(3) would require that “The antibiotic stewardship program adheres to nationally recognized guidelines, as well as best practices, for improving antibiotic use.”
• § 485.640(c)(2)(i) would require “The development and implementation of facility-wide infection surveillance, prevention, and control policies and procedures that adhere to nationally recognized guidelines.”
• § 485.640(c)(3)(i) would require “The development and implementation of a facility- wide antibiotic stewardship program, based on nationally recognized guidelines, to monitor and improve the use of antibiotics.

The AAPS believes that physicians should be the judge of antibiotic use for patients on an individual basis, and should not have to comply with privately-developed guidelines. They also reference a study conducted by The Pew Charitable Trusts that discovered the proposed rule would decrease antibiotic use by 47 million prescriptions.

While this very well may decrease the number of unnecessary prescriptions, it could also harm patients who require the drugs.

“Treatment with antibiotics may be the best treatment in cases where follow-up monitoring is difficult, when diagnostic tests are unavailable, or when test results are not received in a timely manner,” they wrote.

These guidelines could interfere with the best practices of physicians, and could lead to severe adverse events. AAPS further states that Medicare should not be imposing guidelines from a private organization that may have conflicts of interest.

The US Constitution does not allow the government to regulate medicine this way and the requirements of the proposed rules should be removed, the AAPS concluded.